Types of Myasthenia Gravis Crisis

Written by Zhang Hui
Neurology
Updated on September 17, 2024
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Myasthenia gravis is a neurological disease. It is an autoimmune disorder primarily affecting the neuromuscular junction, leading to symptoms such as pathological fatigue, ptosis, and limb weakness. Myasthenia gravis is termed as such due to its severe nature, including crises that can impair respiratory muscles, leading to respiratory paralysis, respiratory failure, and potentially death. There are three main types of myasthenic crises. The first type is myasthenic crisis, primarily caused by insufficient medication; muscular injections can be used for treatment, and if effective, it indicates a myasthenic crisis. The second type is called cholinergic crisis, resulting from an overdose of acetylcholinesterase inhibitors, with symptoms including muscular twitching and pupil constriction. The third type is called refractory crisis, occurring when the body is insensitive to medication treatments. All these crises pose a life-threatening risk to patients and require immediate management, including tracheal intubation and, if necessary, mechanical ventilation.

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Written by Zhang Hui
Neurology
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The difference between amyotrophic lateral sclerosis and myasthenia gravis

These two are distinctly different diseases. Amyotrophic lateral sclerosis (ALS) refers to a motor neuron disease, which is a degenerative neurological condition primarily affecting the upper and lower motor neurons. Patients may exhibit symptoms such as muscle atrophy, muscle twitching, general weakness, as well as potential difficulties in swallowing, articulation disorders, and atrophy of the tongue muscles. The mechanism of this disease is not very clear, symptoms progressively worsen, and there are no effective treatment methods. Neurogenic changes can be observed in electromyography. Myasthenia gravis, on the other hand, is a typical neuromuscular junction disease caused by immune dysfunction. It presents with skeletal muscle fatigue and weakness, typically worsening in the evening. Treatment with immunosuppressants has been shown to be effective.

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Written by Zhang Hui
Neurology
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Myasthenia Gravis Clinical Manifestations

Myasthenia gravis is a type of immunological disease of the nervous system that belongs to neurology. The common clinical manifestations include the following aspects. First, some patients may experience ptosis, where they cannot open their eyes. It usually starts on one side and may also involve abnormal eye movements, such as difficulty in moving the eyes to the left or right, leading to double vision and other clinical manifestations. Second, some patients may experience dysphagia, such as difficulty swallowing, choking on water, and speech articulation disorders. Third, some patients may experience weakness in their limbs, especially an inability to perform strenuous physical activities, such as climbing stairs, which can be significantly affected. These clinical manifestations usually show a pattern of being less severe in the morning and more severe in the evening.

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Written by Zhang Hui
Neurology
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How is myasthenia gravis diagnosed?

Myasthenia gravis is essentially an immunoreactive disease in neurology, primarily caused by immune dysfunction in the body, leading to the production of autoantibodies. These antibodies attack the acetylcholine receptors on the postsynaptic membrane, resulting in corresponding clinical symptoms such as ptosis, diplopia, and general fatigue. The examination of myasthenia gravis mainly includes the following aspects: first, the completion of the Tensilon test, and if the test is positive, myasthenia gravis should be considered; second, the examination should include repetitive nerve stimulation electromyography, and if there is a significant decrement in wave amplitude, this disease should be considered; third, relevant blood tests should be conducted, mainly to check for acetylcholine receptor antibodies, as positive results for these antibodies are important in supporting this diagnosis.

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Written by Tang Bo
Neurology
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Myasthenia Gravis Clinical Manifestations

The clinical manifestations of myasthenia gravis include fluctuating weakness of specific striated muscles that is fatigue-prone. Symptoms are generally milder in the morning and worsen by night, increasing after sustained activity and alleviating after rest. Additionally, some patients may experience ocular muscle weakness, presenting with ptosis and diplopia, which could be among the earliest symptoms. Eye movement disorders may occur, preventing the eyes from looking to one side, and pupil abnormalities may be present. Facial muscle weakness can lead to cheek puffing and air leakage, inability to close the eyes, or asymmetry of the mouth, resembling a forced smile. There may also be weakness in the masticatory muscles, leading to difficulties in chewing and swallowing, potential speech impairments, and coughing when drinking water. Neck muscle weakness may manifest as difficulty in lifting the head. Muscle weakness can affect various limbs, primarily proximally, and respiratory muscle weakness can lead to breathing difficulties and dryness.

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What are the side effects of taking steroid medication for myasthenia gravis?

The side effects of steroids in treating myasthenia gravis mainly include Cushing's syndrome characterized by specific facial and bodily features, weight gain, swelling in the lower legs, purple striae, tendency to bleed easily, poor wound healing, acne, and menstrual disorders. There could also be ischemic necrosis of the femoral or humeral heads, osteoporosis and fractures, primarily compressive vertebral fractures, as well as pathological fractures of the long bones, muscle weakness, muscle atrophy, and hypokalemia syndrome. Gastrointestinal irritation is common, primarily nausea and vomiting, as well as peptic ulcers or perforation, pancreatitis, and suppressed growth in children.