Myasthenia Gravis

Gwathmey, Kelly; Burns, Ted M.

doi:10.1055/s-0035-1558975

Cited by 38 publications

(24 citation statements)

References 151 publications

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“…This was likely due to thiamine deficiency secondary to poor nutrition, and explained the distal sensorimotor axonal polyneuropathy affecting lower more than upper limbs, a classical neurological manifestation present in our patient 2. Concomitant folate deficiency also contributed synergistically to this patient’s neurological symptoms 3 4…”

Section: Investigationsmentioning

confidence: 70%

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Starvation-induced diplopia and weakness: a case of beriberi and Wernicke’s encephalopathy

Tan¹,

Lim

Chung

et al. 2019

BMJ Case Rep

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A 56-year-old teetotaller man with hypertension and gout presented with a week duration of painless worsening diplopia on a background of loss of weight and appetite, generalised lethargy and weakness for 1 year. On examination, he was noted to be hypothermic and tachycardic with generalised muscle wasting. Proximal myopathy, lower limb fasciculations and areflexia, restricted bilateral eye abduction and nystagmus were observed. Blood investigations demonstrated compensated lactic acidosis, acute kidney injury and leucocytosis. A nerve conduction study showed severe length-dependent axonal sensorimotor polyneuropathy. This was a diagnostic dilemma until an MRI brain revealed symmetrical signal abnormality and enhancement in the periaqueductal area indicative of Wernicke’s encephalopathy, caused by thiamine deficiency from poor nutrition. Beriberi, also caused by thiamine deficiency, accounted for his tachycardia, polyneuropathy, areflexia, hypothermia and biochemical abnormalities. Both beriberi and Wernicke’s encephalopathy are medical emergencies, which were treated with intravenous thiamine to good effect.

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Section: Investigationsmentioning

confidence: 70%

“…Myasthenia gravis can also present with proximal limb and ocular muscle weakness, with diplopia being one of the most common presenting complaints 4 5. However, ptosis and fatigability were absent.…”

Section: Differential Diagnosismentioning

confidence: 99%

Starvation-induced diplopia and weakness: a case of beriberi and Wernicke’s encephalopathy

Tan¹,

Lim

Chung

et al. 2019

BMJ Case Rep

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“…The picture of fluctuating, asymmetric external ophthalmoplegia with ptosis and weak eye closure is virtually diagnostic of myasthenia. 5,6 We report an atypical MG case with three semiological cardinal signs.…”

Section: Introductionmentioning

confidence: 92%

Anti-musk positive myasthenia gravis and three semiological cardinal signs

et al. 2017

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Myasthenia gravis (MG) is a relatively uncommon disorder with an annual incidence of approximately 7 to 9 new cases per million. The prevalence is about 70 to 165 per million. The prevalence of the disease has been increasing over the past five decades. This is thought to be due to better recognition of the condition, aging of the population, and the longer life span of affected patients. MG causes weakness, predominantly in bulbar, facial, and extra-ocular muscles, often fluctuating over minutes to weeks, in the absence of wasting, sensory loss, or reflex changes. The picture of fluctuating, asymmetric external ophthalmoplegia with ptosis and weak eye closure is virtually diagnostic of myasthenia. We report an atypical MG case with three semiological cardinal signs.

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“…For a complete discussion of immunosuppressive agents in MG, we refer the reader to the excellent review by Gwathmey and Burns. 43 An algorithm for ICU management of myasthenic crisis is provided in ►Fig. 1.…”

Section: Pharmacotherapymentioning

confidence: 99%

Getting Rid of Weakness in the ICU: An Updated Approach to the Acute Management of Myasthenia Gravis and Guillain-Barré Syndrome

2016

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After prompt diagnosis, severe myasthenia gravis and Guillain-Barré syndrome (GBS) usually require management in the intensive care unit. In the myasthenic patient, recognition of precipitating factors is paramount, and frequent monitoring of bulbar, upper airway, and/or respiratory muscle strength is needed to identify impending myasthenic crisis. Noninvasive ventilation can be attempted prior to intubation and mechanical ventilation in the setting of respiratory failure. Cholinesterase inhibitors should be discontinued, but resumed prior to extubation, and steroid dosage could be increased once the airway is secured. In GBS, hemodynamic and respiratory monitoring are essential; however, respiratory failure can develop rapidly and intubation with mechanical ventilation is often required and can be prolonged. Guillain-Barré syndrome can also be complicated by dysautonomia necessitating specific therapies. Prompt recognition and initiation of immunotherapy including intravenous immunoglobulin or plasmapheresis, together with supportive care including treatment of underlying infections and physical therapy, can improve outcomes in both myasthenic crisis and GBS.

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Myasthenia Gravis

Cited by 38 publications

References 151 publications

Starvation-induced diplopia and weakness: a case of beriberi and Wernicke’s encephalopathy

Starvation-induced diplopia and weakness: a case of beriberi and Wernicke’s encephalopathy

Anti-musk positive myasthenia gravis and three semiological cardinal signs

Getting Rid of Weakness in the ICU: An Updated Approach to the Acute Management of Myasthenia Gravis and Guillain-Barré Syndrome

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