Myasthenia gravis

Myasthenia gravis - Acute
Rahul Soman, M. Pharm

 

Definition  

An autoimmune disease of the neuromuscular junction marked by fatigable weakness of striated muscles .

 

Medical History  

* Neoplasm of thymus

* Penicillamine use

* Pregnancy

* Infectious disease

* Anesthetic, General use

 

Findings  

* Acute respiratory failure

* Diplopia

* Dyspnea - Acute

* Muscle weakness

* Ptosis of eyelid

* Weakness of face muscles

* Bulbar weakness

* Normal tendon reflex

* Pupil reactions normal

 

Tests  

 

Suspected myasthenia gravis  

* Edrophonium chloride test for myasthenia gravis: Edrophonium administration will transiently improve strength in patients with myasthenia gravis, but testing is subjective and not specific .

 

Differential Diagnosis  

* Myasthenic crisis

* Cholinergic crisis

* Guillain-Barré syndrome - Acute

* Brainstem stroke syndrome

* Botulism - Acute

* UNITED STATES SNAKES CROTALINAE

* SPIDERS, OTHER

* SCORPIONS

 

Treatment  

 

Drug Therapy  

 

Myasthenia gravis  

 

IMMUNE GLOBULIN  

Adults: 2 g/kg IV administered over 2 to 5 days

 

Procedural Therapy  

 

Respiratory distress  

* Airway management: Airway management must assume the first priority in the management of any seriously ill or injured patient .

 

Myasthenia gravis  

* Therapeutic plasma exchange: Plasma exchange is used for short-term treatment of myasthenia gravis; it may be used for long-term treatment in patients refractory to other therapy .