Myasthenia Gravis and Upper Airway Obstruction

Putman, Maryann; Wise, Robert A.

doi:10.1378/chest.109.2.400

Cited by 47 publications

(45 citation statements)

References 13 publications

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“…El compromiso respiratorio inicial en la MG es infrecuente, incluso algunos autores aseveran que "nunca es el primer síntoma de la enfermedad" 9 . La dificultad respiratoria en crisis se debe casi exclusivamente a debilidad diafragmática y de musculatura intercostal, no a alteraciones de la vía aérea superior 10 . Sólo se conocen reportes aislados de MG laríngea, con paresia y parálisis cordal de inicio agudo 11 , pero se trata de pacientes mayores a 40 años, con diagnóstico previo de MG, quienes ya han presentando síntomas oculares o generalizados 10 .…”

Section: Discussionunclassified

Estridor y dificultad respiratoria: aproximación neurológica. Caso clínico

2017

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E l movimiento paradojal de cuerdas vocales (MPCV) es un trastorno de muy baja frecuencia. Se manifiesta como una obstrucción glótica episódica, en la cual, las cuerdas vocales aducen de forma inapropiada en inspiración y/o espiración 1 . Puede causar un episodio súbito de estridor y dificultad respiratoria, que puede ser muy alarmante 2 . Este fenómeno ha asumido variados nombres a través del tiempo, como "estridor psicógeno" y "obstrucción funcional de la vía aérea superior", entre otros 3 . Fue inicialmente descrito por Patterson en 1974 como "estridor de Munchausen", en una mujer de 33 años con historia de 15 hospitalizaciones por crisis obstructivas 4 , sugiriendo desde ese entonces una posible etiología psiquiátrica. El diagnóstico es difícil de establecer, dado que se basa principalmente en la visualización directa, mediante laringoscopía, de las cuerdas vocales mientras el paciente tiene síntomas. Debido a esto, es frecuente que los pacientes usualmente sean mal diagnosticados, tratados como asmáti-cos, sometidos a intubaciones, traqueostomías, altas dosis de corticoides y múltiples hospitalizaciones 5 .Presentamos el caso de una paciente joven, que presentó crisis recurrentes de estridor laríngeo con dificultad respiratoria, sometida a múltiples intubaciones y traqueostomizada en dos ocasiones. Esta comunicación cuenta con la aprobación

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Section: Discussionunclassified

Estridor y dificultad respiratoria: aproximación neurológica. Caso clínico

2017

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“…The occurrence of respiratory insufficiency without generalized weakness in patients is rare. 9 The common precipitating factors for MC include respiratory infections, aspiration, sepsis, surgical procedures, rapid tapering of immune modulation agents, starting corticosteroids treatment, exposure to drugs [antibiotics (aminoglycosides, erythromycin and azithromycin), cardiac drugs (beta-blockers, procainamide, and quinidine), and magnesium] that may increase myasthenic weakness and pregnancy. Furthermore, MC can occur spontaneously as part of the natural history of MG itself.…”

Section: Discussionmentioning

confidence: 99%

Myasthenia gravıs with acute respiratory failure in the the emergency department

Kozak¹

2015

Tr J Emerg Med

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a b s t r a c tAcute respiratory failure (ARF) is defined as a sudden malfunction in the ability of respiratory system to maintain adequate gas exchange. Acute hypercapnic respiratory failure develops as a result of ventilation deficiency and it is defined as an increase of PaCO 2 above 45 mmHg. Myasthenia Gravis (MG) is a sporadically developing auto-immune deficiency where the neuro-muscular transmission is affected and it is one of the important reasons for neurologically-induced respiratory distress. Here, we report a case of a 75-year-old male patient previously undiagnosed MG, who presented with ARF. MG is not a common entity that we encounter daily. Patients on occasions may present to the emergency department because of acute exacerbation. Though most of them were known cases, we should be aware of some unrecognized cases and should consider MG as a differential diagnosis for patients with acute respiratory failure.

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“…Muscle weakness in AchR-MG tends to initially affect the intercostal and accessory muscles and then the diaphragm (Chaudhuri and Behan, 2009). Bulbar (oropharyngeal) muscle dysfunction may be the predominant feature in some patients (Putman and Wise, 1996). In MuSK-MG, bulbar weakness always precedes respiratory failure (Chaudhuri and Behan, 2009).…”

Section: Pathophysiology and Clinical Presentationsmentioning

confidence: 99%

“…As it is well established, the involvement of upper airway muscles in neuromuscular diseases can produce abnormalities of the maximum flow-volume loop (MFVL) in the form of upper airway obstruction and/or flow oscillations (Putman and Wise, 1996). Upper airway obstruction is much more common in patients with MG than previously recognized.…”

Section: Assessment Of Bulbar Functionmentioning

confidence: 99%

“…Upper airway obstruction is much more common in patients with MG than previously recognized. In one study, 7 of the 12 MG patients examined disclosed a pattern of extrathoracic upper airway obstruction (Putman and Wise, 1996). In addition, a crude but effective bedside test can be performed by asking the patient to sip water and then observing for coughing or choking.…”

Section: Assessment Of Bulbar Functionmentioning

confidence: 99%

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