Loss of motor function after sedation

My 35 year old sister landed in ICU due to complications from Leukemia chemotherapy. She was extubated after 17 days of deep sedation and mechanical ventilation. During her sedation (a cocktail of Versed, Fentenyl and Diprivan) she suffered the typical effects of chemo - CBC basically non existent, spiking high fevers, etc. As well as the atypical effects of failing kidneys and liver function. After three of four days on hemodialysis her toxin level became safe, her kidneys took over again plus her billirubin levels began to drop. After extubation she was dellusional and she had complete weakness in her arms and legs. Her thoughts became clear after three days but she still cannot move her arms and legs. A CT scan ruled out a brain bleed. An EMG discovered some minor nerve damage but nothing notable. A spinal tap revealed no protein on her spine. She has full sensation in all of her extremeties - she just can't move them - although her legs are showing some improvement with PT. One other observation I did make the day before she was extubated was that she flailed both her legs in bed during a time of distress with no problem. Is there an explanation for this effect that her Docs may be missing? Or a suggestion that I could bring to them? They seem stumped and tell us there is no good reason that this condition exists and don't know where else to look. Any advice from the Docs or anyone else who finds this familiar will help!

Thank you

[CCF-Neuro-M.D.-CS]

Without examining your sister and taking her history I cannot make a clinical diagnosis. A few possibilities include: critical illness polyneuropathy and critical illness myopathy. The polyneuropathy is a disorder which causes damage to the nerves in the body. This then results in weakness. However, in your sisters case the EMG (muscle/nerve test) had only minimal changes. A myopathy is a disease process which affects the muscles and results in weakness. In the case of critical illness myopathy this is associated with a severe illness, and often with use of agents to paralyze muscles (to help with mechanical ventilation). Another possibility would be a disorder affecting the communication between the nerves and the muscles (a neuromuscular junction disorder). Some medications (such as some anti-biotics) can cause this. These would be the major categories I would consider. For the critical illness associated nerve or muscle damage there are no specific treatments, and patients typically recover over weeks to months. Good luck.