Excess or Paucity: Making Sense of Movements

A movement disorder is not just a matter of discomfort or disability. More worrisome is that movement disorders lead to a host of secondary complications. Dystonic involvement of the chest wall, neck, and respiratory muscles may cause acute respiratory compromise requiring mechanical ventilation. Excess (hyperkinetic) movements sustained over a period of time increase the risk of muscle breakdown. If patients experience paroxysmal sympathetic hyperactivity, profound dysautonomia often accompanies the uncontrolled movements. It is therefore necessary to recognize these movements and treat some of them urgently. In this chapter, the clinical semiology of movement disorders seen in intensive care units is described to aid recognition. Moreover, we will discuss when they are relevant for day-to-day critical care management.