{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T16:46:26Z","timestamp":1788281186217,"version":"build-2803163510"},"reference-count":29,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2002,8,12]],"date-time":"2002-08-12T00:00:00Z","timestamp":1029110400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Muscle and Nerve"],"published-print":{"date-parts":[[2002,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Areflexic quadriplegia that occurs in the intensive care unit (ICU) is commonly ascribed to critical illness polyneuropathy based upon electrophysiology or muscle light microscopy. However, electron microscopy often documents a selective thick filament loss myopathy. Eight ICU patients who developed areflexic quadriplegia underwent biopsy. Seven patients had received steroids, and 2 had also received paralytic agents. Electrodiagnostic studies revealed absent or low\u2010amplitude motor responses in 7. Sensory responses were normal in 5 of 6 and absent in 1. Initial electromyography revealed absent (<jats:italic>n<\/jats:italic> = 3), small (<jats:italic>n<\/jats:italic> = 3), or polyphasic (<jats:italic>n<\/jats:italic> = 1) motor unit potentials, and diffuse fibrillation potentials (<jats:italic>n<\/jats:italic> = 5). In all 8, light microscopy of muscle revealed numerous atrophic\u2010angulated fibers and corelike lesions, and electron microscopy revealed extensive thick filament loss. Morphology of sural and intramuscular nerves, and, in one autopsied case, of the obturator nerve and multiple nerve roots, was normal. Although clinical, electrodiagnostic, and light microscopic features mimicked denervating disease, muscle electron microscopy revealed thick filament loss, and nerve histology was normal. This suggests that areflexic ICU quadriplegia is a primary myopathy and not an axonal polyneuropathy. \u00a9 2002 Wiley Periodicals, Inc. Muscle Nerve 26: 499\u2013505, 2002<\/jats:p>","DOI":"10.1002\/mus.10233","type":"journal-article","created":{"date-parts":[[2002,10,9]],"date-time":"2002-10-09T05:48:03Z","timestamp":1034142483000},"page":"499-505","source":"Crossref","is-referenced-by-count":61,"title":["Quadriplegic areflexic ICU illness: Selective thick filament loss and normal nerve histology"],"prefix":"10.1002","volume":"26","author":[{"given":"Howard W.","family":"Sander","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianna","family":"Golden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moris J.","family":"Danon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2002,8,12]]},"reference":[{"key":"e_1_2_7_2_2","doi-asserted-by":"publisher","DOI":"10.1172\/JCI118566"},{"key":"e_1_2_7_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/mus.880170613"},{"key":"e_1_2_7_4_2","first-page":"64","volume-title":"Pathology of skeletal muscle","author":"Carpenter S","year":"2001"},{"key":"e_1_2_7_5_2","doi-asserted-by":"publisher","DOI":"10.1002\/mus.880141115"},{"key":"e_1_2_7_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0960-8966(98)00003-0"},{"key":"e_1_2_7_7_2","first-page":"984","volume-title":"Myology: basic and clinical","author":"Engel AG","year":"1994"},{"key":"e_1_2_7_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-4598(199711)20:11<1371::AID-MUS4>3.0.CO;2-7"},{"key":"e_1_2_7_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/00019052-199310000-00004"},{"key":"e_1_2_7_10_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-4598(199802)21:2<266::AID-MUS26>3.0.CO;2-Z"},{"key":"e_1_2_7_11_2","doi-asserted-by":"publisher","DOI":"10.1002\/1097-4598(200012)23:12<1785::AID-MUS1>3.0.CO;2-J"},{"key":"e_1_2_7_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-200001000-00006"},{"key":"e_1_2_7_13_2","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1001\/jama.1995.03530150045032","article-title":"The role of polyneuropathy in motor convalescence after prolonged mechanical ventilation","volume":"274","author":"Leijten FS","year":"1995","journal-title":"JAMA"},{"key":"e_1_2_7_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/00131402-200003000-00007"},{"key":"e_1_2_7_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(77)91471-4"},{"key":"e_1_2_7_16_2","doi-asserted-by":"publisher","DOI":"10.1172\/JCI112344"},{"key":"e_1_2_7_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/0303-8467(94)90080-9"},{"key":"e_1_2_7_18_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199709183371217"},{"key":"e_1_2_7_19_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005072-199307000-00006"},{"key":"e_1_2_7_20_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-4598(199706)20:6<665::AID-MUS2>3.0.CO;2-6"},{"key":"e_1_2_7_21_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.1016"},{"key":"e_1_2_7_22_2","first-page":"1057","article-title":"Phrenic nerve conduction studies in the intensive care unit","volume":"19","author":"Saadeh PB","year":"1996","journal-title":"Muscle Nerve"},{"key":"e_1_2_7_23_2","first-page":"3","article-title":"Diaphragmatic denervation in intensive care unit patients","volume":"39","author":"Sander HW","year":"1999","journal-title":"Electromyogr Clin Neurophysiol"},{"key":"e_1_2_7_24_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199704103361508"},{"key":"e_1_2_7_25_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.29.1.100"},{"key":"e_1_2_7_26_2","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-4598(199703)20:3<316::AID-MUS8>3.0.CO;2-E"},{"key":"e_1_2_7_27_2","doi-asserted-by":"publisher","DOI":"10.1002\/1097-4598(2000)999:9<::AID-MUS9>3.0.CO;2-9"},{"key":"e_1_2_7_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-510X(98)00164-6"},{"key":"e_1_2_7_29_2","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/110.4.819"},{"key":"e_1_2_7_30_2","doi-asserted-by":"publisher","DOI":"10.1002\/mus.880170305"}],"container-title":["Muscle &amp; 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