1/11. Bulbar presentations of myasthenia gravis in the elderly patient.We report on three cases of patients whose primary symptoms of myasthenia gravis were related to the upper aerodigestive tract. Symptoms had been present unrecognized in all patients for up to three years, and one patient subsequently developed a myasthenic crisis. We highlight the clinical features of myasthenia gravis to allow its prompt recognition in patients presenting to the ENT surgeon or physician.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/11. colon carcinoma after thymectomy for myasthenia gravis: report of a case.A 74-year-old Japanese man was admitted to our hospital with anemia, 4 years after a thymectomy for thymoma associated with myasthenia gravis. A diagnosis of sigmoid colon carcinoma was confirmed, followed by surgical resection. This case is presented to reinforce that physicians should bear in mind the possibility of extrathymic malignancies in patients with thymoma.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/11. Treatment of post-herpetic pain in myasthenia gravis: exacerbation of weakness due to gabapentin.Here, we present a case of a 64-year-old female suffering from a severe form of antibody-positive myasthenia gravis. Under an immunosuppressive regimen with cyclosporine A, she experienced an episode of thoracic herpes zoster followed by intense post-herpetic neuralgia. In order to avoid drug interactions as well as adverse effects of carbamazepine in myasthenia gravis, gabapentin was chosen for the treatment of neuropathic pain. Within a few days she noticed increasing weakness, but continued medication for 8 weeks as gabapentin was not identified as the hazardous agent by her physician. acetylcholine receptor antibody levels remained unchanged, but increased decrement was observed clinically and in repetitive nerve stimulation. After withdrawal of gabapentin, she recovered quickly to her previous condition.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/11. A middle-aged woman with an anterior mediastinal mass and respiratory failure.The discovery of an anterior mediastinal mass presents a challenge to the physician. In addition to distinguishing between benign and malignant conditions, it is important to recognize the potential for associated paraneoplastic phenomena. We present a case of a malignant thymoma associated with myasthenia gravis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/11. myasthenia gravis.These three case histories exemplify current treatment strategies and prognosis in a previously chronic, severe and sometimes life-threatening disease. The nurse's challenge in working with and caring for these individuals include: patient education-concerning disease process, medications and cholinergic vs myasthenic crisis. Long term emotional support of both the patient and family are important in a disease which may take years before remission occurs. Patient support groups and literature may often be of benefit. The hospital stay for a myasthenic may be relatively short (e.g. during thymectomy only). The home health care team, family physician, and outpatient neurological team rely on the patient and his family to have a solid knowledge base and continual telephone contact in order to maintain optimal care. immunosuppression and plasmapheresis may well be a contributing factor to improved prognosis and cure in a previously "grave" disease.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/11. multiple sclerosis, euthyroid restrictive Grave's ophthalmopathy, and myasthenia gravis. A case report.A 53-year-old physician with a 13-year history of multiple sclerosis presented with the subacute onset of an atypical, restrictive, euthyroid Grave's ophthalmopathy. The hypotropia and monocular upgaze restriction responded to a course of systemic and local steroids. Three months later, the patient developed ocular and systemic features of myasthenia gravis. This is the second reported case of coincident multiple sclerosis, myasthenia gravis, and thyroid-related disease complex.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/11. Exacerbation of a case of myasthenia gravis during therapeutic electric stimulation.In patients with myasthenia gravis, vigorous exercise and electric stimulation produce weakness that is usually reversed by rest. We describe a case of persistent weakness in a 31-year-old woman with myasthenia gravis following therapeutic electric stimulation. She was injured in an automobile accident, with cervical and lumbar muscle strain diagnosed by a local emergency room physician. She consulted a chiropractor two days later because her symptoms had not abated. The chiropractic treatment of short-wave diathermy, high-voltage electric stimulation and spinal manipulation continued thrice weekly for six weeks. She then presented to her neurologist, complaining of persistent fatigue, weakness, increased diplopia, cervical and occipital pain, and disrupted sleep. neck weakness had developed since her last visit. She was admitted to the hospital for evaluation. Neurologic exam showed no other abnormality of strength, sensation, or reflexes. The exacerbation of myasthenia responded to prednisone and increased pyridostigmine. After two months she required only her preinjury dose of pyridostigmine (60 mg q.d. p.r.n.) to prevent diplopia or fatigue, and her strength was normal. Repeated electrically induced muscle contraction is suspected of causing this exacerbation of myasthenia gravis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/11. plasma exchange in the management of acute polyradiculopathy and myasthenic crisis (plasma exchange in neurological disorders).Six patients with acute severe neurological illnesses were managed by plasma exchange on the basis that their diseases were triggered by immune mechanisms. These included one case of acute post-infectious encephalomyeloradiculopathy, two cases of Guillain Barre syndrome or acute polyradiculoneuropathy and three patients in myasthenic crisis. There were no convincing responses in the patients with Guillain Barre syndrome. All three myasthenic patients showed improvement that was sufficiently dramatic to warrant continued use of this therapeutic procedure. Based on our experience and reports by others it is felt that in acute polyradiculoneuropathy plasmapheresis would be beneficial only if the disease is predictably deteriorating and should be done within the first few days. In myasthenic crises its role is more definite and it shortens significantly the duration of assisted ventilation and the length of severe relapse. The procedure also gives the physician sufficient time to effectively immunosuppress the patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/11. Interpretation of positive edrophonium (Tensilon) test in patients with end-stage renal disease.Many patients with end-stage renal disease (ESRD) have signs and symptoms of easy fatigability, fluctuating weakness, apathy, dry mouth, and blurring of vision. These symptoms can be confused with disorders of neuromuscular transmission. When present, the physician may want to determine whether the patient has myasthenia gravis--the commonest of all neuromuscular disorders--and administer the edrophonium (Tensilon) test. An unequivocally positive response to the test must be interpreted with caution in ESRD. However, the exact mechanism of a positive response is unclear but may be explained by metabolic abnormalities related to end-stage renal disease, i.e., uremic toxins, disordered calcium metabolism, abnormal neuromuscular mechanism, associated neurological disorders, or myopathic processes in uremia, all of which can affect neuromuscular transmission.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/11. Coexisting childhood schizophrenia and myasthenia gravis treated successfully with neostigmine bromide.A 12-year-old boy who had suffered from severe schizophrenia for 8 years developed myasthenia gravis. Both disorders were treated simultaneously and successfully with neostigmine bromide. The authors suggest that these two disorders may in some cases be part of the same disease process and urge that physicians consider this possibility in patients with severe emotional problems and muscle weakness.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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