- Dedication
- Preface
- Acknowledgments
- 1 A 35-Year-Old Man with Progressive Left-Hand Weakness
- 2 A 54-Year-Old Male with Right-Hand Weakness
- 3 A 50-Year-Old Male with Speech, Swallowing, and Behavioral Difficulties
- 4 A 45-Year-Old Male with Toxin Exposure
- 5 A 48-Year-Old with Progressive Weakness and Pain
- 6 A 30-Year-Old Male Requiring Management of Progressive Weakness
- 7 A 61-Year-Old Male with Severe Shoulder and Cervical Pain
- 8 A 55-Year-Old Male with Right Foot Weakness
- 9 A 63-Year-Old Male with Severe Flaccid Weakness Post Motor Vehicle Accident
- 10 A 55-Year-Old Female with Slowly Progressive Weakness
- 11 A 40-Year-Old Female with Balance Problems and Numbness After Bariatric Surgery
- 12 A 55-Year-Old Female with a History of Right Foot Drop and Left Hand Weakness
- 13 A 40-Year-Old Female with Increasing Arm Pain and Numbness
- 14 A 59-Year-Old Man with Progressive Difficulties with Balance and Weight Loss
- 15 A 68-Year-Old Male with Progressive Numbness and Gait Difficulties
- 16 A 28-Year-Old Male with Weakness in the Setting of Cancer
- 17 A 44-Year-Old Man with Bilateral Facial Droop
- 18 A 41-Year-Old Male with Foot Drop and Malaise
- 19 A 44-Year-Old Female with Buttock Pain
- 20 A 50-Year-Old Woman with Burning Feet
- 21 A 56-Year-Old Woman with Small-Fiber Neuropathy and Progressive Leg Pain and Weakness
- 22 A 34-Year-Old Male with Possible Myopathic Process
- 23 A 39-Year-Old Man with Low Back Pain and Scapular Winging
- 24 A 52-Year-Old Female with Weakness and Droopy Eyelids
- 25 A 20-year-Old Male with Acute Lower-Extremity Weakness
- 26 A 19-Year-Old Male with Stiffness and Weakness After Waking
- 27 A 68-Year-Old Female with Progressive Pain and Weakness
- 28 An 18-Year-Old Male with Slowly Progressive Weakness
- 29 A 30-Year-Old Male with Severe Cramps
- 30 A 72-Year-Old Female with Facial Weakness and Droopy Eyelids
- 31 An 80-Year-Old Myasthenia Gravis Patient with Worsening Weakness
- 32 A 44-Year-Old Male with Subacute Onset of Syncope
- 33 A 46-Year-Old Man with Double Vision and Proximal Leg Weakness
- 34 A 2-Month-Old Boy with Acute Diffuse Weakness
- Index
(p. 191) An 80-Year-Old Myasthenia Gravis Patient with Worsening Weakness
- Chapter:
- (p. 191) An 80-Year-Old Myasthenia Gravis Patient with Worsening Weakness
- Author(s):
Jeffrey A. Cohen
, Justin J. Mowchun
, Victoria H. Lawson
, and Nathaniel M. Robbins
- DOI:
- 10.1093/med/9780190491901.003.0031
In myasthenia gravis, weakness and respiratory insufficiency can occur quickly. It is important for the treating physician to recognize this and institute treatment rapidly. Increasing weakness of the neck may herald impending respiratory insufficiency. The single breath count is an easy way ti assess ventilatory function. Because of bulbar weakness and increasing secretions usually bi-level positive pressure airway pressure is used with extreme caution. Intubation with effective management if the airway is preferred. Differentiation of myasthenic crisis from cholinergic crisis is explained; although cholinergic crisis is relatively uncommon. Treatment modalities can include intravenous immunoglobulin, plasma exchange, and corticosteroids. Corticosteroids should be used with caution since they may exacerbate myasthenic symptoms. Treatment with a steroid sparing agent is discussed. A table is presented which lists signs and symptoms that can suggest the need for intubation.
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- Dedication
- Preface
- Acknowledgments
- 1 A 35-Year-Old Man with Progressive Left-Hand Weakness
- 2 A 54-Year-Old Male with Right-Hand Weakness
- 3 A 50-Year-Old Male with Speech, Swallowing, and Behavioral Difficulties
- 4 A 45-Year-Old Male with Toxin Exposure
- 5 A 48-Year-Old with Progressive Weakness and Pain
- 6 A 30-Year-Old Male Requiring Management of Progressive Weakness
- 7 A 61-Year-Old Male with Severe Shoulder and Cervical Pain
- 8 A 55-Year-Old Male with Right Foot Weakness
- 9 A 63-Year-Old Male with Severe Flaccid Weakness Post Motor Vehicle Accident
- 10 A 55-Year-Old Female with Slowly Progressive Weakness
- 11 A 40-Year-Old Female with Balance Problems and Numbness After Bariatric Surgery
- 12 A 55-Year-Old Female with a History of Right Foot Drop and Left Hand Weakness
- 13 A 40-Year-Old Female with Increasing Arm Pain and Numbness
- 14 A 59-Year-Old Man with Progressive Difficulties with Balance and Weight Loss
- 15 A 68-Year-Old Male with Progressive Numbness and Gait Difficulties
- 16 A 28-Year-Old Male with Weakness in the Setting of Cancer
- 17 A 44-Year-Old Man with Bilateral Facial Droop
- 18 A 41-Year-Old Male with Foot Drop and Malaise
- 19 A 44-Year-Old Female with Buttock Pain
- 20 A 50-Year-Old Woman with Burning Feet
- 21 A 56-Year-Old Woman with Small-Fiber Neuropathy and Progressive Leg Pain and Weakness
- 22 A 34-Year-Old Male with Possible Myopathic Process
- 23 A 39-Year-Old Man with Low Back Pain and Scapular Winging
- 24 A 52-Year-Old Female with Weakness and Droopy Eyelids
- 25 A 20-year-Old Male with Acute Lower-Extremity Weakness
- 26 A 19-Year-Old Male with Stiffness and Weakness After Waking
- 27 A 68-Year-Old Female with Progressive Pain and Weakness
- 28 An 18-Year-Old Male with Slowly Progressive Weakness
- 29 A 30-Year-Old Male with Severe Cramps
- 30 A 72-Year-Old Female with Facial Weakness and Droopy Eyelids
- 31 An 80-Year-Old Myasthenia Gravis Patient with Worsening Weakness
- 32 A 44-Year-Old Male with Subacute Onset of Syncope
- 33 A 46-Year-Old Man with Double Vision and Proximal Leg Weakness
- 34 A 2-Month-Old Boy with Acute Diffuse Weakness
- Index