Hemiparetic acute myopathy of intensive care progressing to triplegia.
Overview
abstract
OBJECTIVE: To describe a unique case of acute asymmetrical myopathy following high-dose intravenous use of corticosteroids that initially mimicked a stroke and then evolved into a picture suggestive of myelopathy. DESIGN: Case report. SETTING: Tertiary hospital. PATIENTS: A 71-year-old woman treated with high-dose steroids for an acute asthmatic exacerbation developed acute hemiparesis that progressed to triplegia without evidence of central nervous system involvement. RESULTS: Nerve conduction studies, electromyography, and muscle biopsy revealed the typical features of necrotizing myopathy with loss of thick filaments. CONCLUSIONS: This case demonstrates that high-dose corticosteroid therapy can induce asymmetrical myopathic weakness. Hemiplegia evolving to triplegia in a setting of corticosteroid treatment could potentially misdirect the diagnosis toward a lesion of the brain or spinal cord. When a central nervous system abnormality cannot be demonstrated a search for a peripheral abnormality, such as myopathy, is warranted.
