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What is not?

 Impossible is not a fact, its an opinion 

Myesthenia Gravis

May 21, 2010 by drsalman

Case Sheet

A 35 year old female presented to the offce with abnormal fatigue of muscles and intensification of symptoms towards the end of the day or following vigorous exercise.Pateint complain of intermittent ptosis,diplopia,difficulty in swallowing,difficulty in speech-mushy speech.Pateint has a history of hodgins lymphoma with Thymoma on chronic chemothrapy.

      On examination sustaineed activity of muscles leading to temporary weakness.There is mild atropy ofmuscles.Reflexes are normal in all the limbs.

Case Discussion: 

Presynaptic receptors antibodies-LE syndrome

Post synaptic antibodies-Myesthenia

Rules: 

 Ptosis incresing in evening 70

 Weakness incresing in evening or on exercise 60

Diplopia 10

Difficulty in speech-Mushy speech 10

Difficulty in swallowing 10

Atropy of muscles10

Normal reflexes 30

Positive tensilon test 50

Positive Ach Ab 60

Thymic tumors 20

EMG Decremental response 60

Autonomic dysfunction -30

If Mild Myesthenia then Neostigmine=/-Pyridositgmine

If Moderate Myesthenia then Plasmapheresis/IVIG

If severe resistant Myesthenia then Steriods,Azothioprone

If thymoma present with Myesthenia then Thymectomy

 

Questions: 

What is the diagnosis?

What is the best next step in managing this patient?

What is LE syndrome??Staging of Myesthenia??

 

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