Key messages

• Clinical assessment in the intensive care unit is often difficult and misleading.

• Neurological examination and electrophysiological testing of the peripheral nervous system are essential.

• Phrenic nerve conduction and needle electromyography are often valuable.

• Magnetic resonance imaging of the cervical spinal cord and measurement of serum creatine phosphokinase, and muscle biopsy may further establish the diagnosis.

• Conditions such as spinal cord compression and Guillain-Barre syndrome require specific treatment.

• Adequate investigation, as described above, invariably provides important information on prognosis.

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