Flaccid quadriplegia due to thyrotoxic myopathy

Neurocritical Care
Philippe Couillard, Eelco F M Wijdicks

Abstract

Acute flaccid paralysis is an important clinical problem in neurological critical care. After implementing life-supporting measures, it is imperative to identify the correct diagnosis to provide timely appropriate care. Thyrotoxicosis is a recognized cause of myopathy, but rarely of quadriplegia. Here, we report a case of hyperthyroidism with severe weakness. Case report and video demonstration of clinical examination. We describe a case of a 59-year-old woman with Grave's disease who presented to the hospital with progressive shortness of breath secondary to atrial fibrillation with rapid ventricular response. Following contrast administration, she had a pulseless electrical activity arrest from which she recovered without cognitive sequelae, but with flaccid quadriplegia, facial diplegia, and hypophonia. CK was mildly elevated and electrolytes were essentially normal. Nerve conduction studies and electromyography demonstrated features supporting an acute myopathy without evidence of neuromuscular junction conduction abnormality. Normalization of thyroid hormones resulted in slow, but steady improvement over months after which she regained ambulation. Acute flaccid quadriplegia can result from thyrotoxicosis. With normalizatio...Continue Reading

References

May 2, 2006·Thyroid : Official Journal of the American Thyroid Association·Michael D BrennanK Sreekumaran Nair
Nov 14, 2012·CMAJ : Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne·Paul DunneAkheel A Syed

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