ICU Cases · Seizures & weakness
Hot case — the bedside: a myasthenic crisis
A CICM hot case on myasthenic crisis — recognising impending and manifest crisis, the respiratory and bulbar assessment, NIV versus intubation, PLEX or IVIg, and the precipitant and drug review.
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Prompt
At the bedside of a 55-year-old with known myasthenia gravis who is becoming breathless and weak. Assess and manage.
Presentation
You are taken to the bedside of a 55-year-old woman with known AChR-positive myasthenia gravis admitted with pneumonia. She is becoming breathless, has bilateral ptosis, a weak cough and difficulty clearing secretions.[1]
References7ShowHide
- [1]Sanders DB, Wolfe GI, Benatar M, et al. International consensus guidance for management of myasthenia gravis: Executive summary. Neurology, 2016.PMID 27358333
- [2]Seneviratne J, Mandrekar J, Wijdicks EF, et al. Noninvasive ventilation in myasthenic crisis. Archives of neurology, 2008.PMID 18195139
- [3]Thomas CE, Mayer SA, Gungor Y, et al. Myasthenic crisis: clinical features, mortality, complications, and risk factors for prolonged intubation. Neurology, 1997.PMID 9153452
- [4]Gajdos P, Chevret S, Clair B, et al. Clinical trial of plasma exchange and high-dose intravenous immunoglobulin in myasthenia gravis. Myasthenia Gravis Clinical Study Group. Annals of neurology, 1997.PMID 9189040
- [5]Narayanaswami P, Sanders DB, Wolfe G, et al. International Consensus Guidance for Management of Myasthenia Gravis: 2020 Update. Neurology, 2021.PMID 33144515
- [6]Rabinstein AA, Wijdicks EF Warning signs of imminent respiratory failure in neurological patients. Seminars in neurology, 2003.PMID 12870111
- [7]Mandawat A, Kaminski HJ, Cutter G, et al. Comparative analysis of therapeutic options used for myasthenia gravis. Annals of neurology, 2010.PMID 21061395