Lambert-Eaton myasthenic syndrome as a cause of persistent neuromuscular weakness after a mediastinoscopic biopsy -A case report-

Abstract

There are many causes of prolonged postoperative muscle weakness, including drugs, residual anesthetics, cerebrovascular events, electrolyte imbalance, hypothermia, and neuromuscular disease. Neuromuscular diseases are relatively rare, with the most common being myasthenia gravis and Lambert-Eaton myasthenic syndrome (LEMS). We report an unusual case in which a patient who was given a muscle relaxant during mediastinoscopy developed postoperative muscle weakness that was ultimately diagnosed as secondary to LEMS.

Lambert Eaton Myasthenic Syndrome diagnosed following prolonged neuromuscular blockade: beware the patient with weak legs

“…A further case report was a patient undergoing a thyroidectomy who received vecuronium for muscle paralysis and subsequently their lungs required mechanical ventilation for 16 hours [5]. Other cases mentioned in the literature describe a new onset of LEMS in a patient with para-neoplastic subacute cerebellar degeneration who underwent general anaesthesia [7] and a new diagnosis of LEMS after anaesthesia in a patient who had a mediastinal biopsy [1].…”

“…These antibodies inhibit acetylcholine release, preventing nerve transmission at the motor end plate and resulting in muscle weakness. LEMS is most commonly associated with proximal lower limb weakness [1].…”

“…LEMS can occur either with or without an underlying malignancy. Reports have most commonly been associated with small cell lung cancer [1], affecting approximately 50% of patients with LEMS [2]. The association is strong enough that a clinical scoring system has been derived to identify small cell lung cancer early in the course of LEMS [2].…”