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首页> 外文期刊>American Journal of Case Reports >Cranial Nerve IX and X Weakness: An Unusual Initial Presentation of Myasthenia Gravis
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Cranial Nerve IX and X Weakness: An Unusual Initial Presentation of Myasthenia Gravis

机译：颅神经IX和x弱点：肌无力的肌炎肌无力呈现

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Patient: Female, 51-year-old Final Diagnosis: Myasthenia gravis Symptoms: Dysphonia ? hoarseness Medication:— Clinical Procedure: — Specialty: Critical Care Medicine ? Neurology ? Pulmonology Objective: Challenging differential diagnosis Background: Myasthenia gravis (MG) is an autoimmune disease characterized by antibodies binding skeletal muscle acetylcholine receptors (AChR). Rarely does the disease manifest with orolaryngeal symptoms before ocular ones. We present a case of MG that on initial presentation had symptoms of cranial nerves (CN) IX and X weakness, including dysphagia and dysphonia. Case Report: A 51-year-old woman with panic attacks presented to the Emergency Department (ED) with complaints of her throat closing, swallowing difficulty, and hoarse voice. Multiple ED visits revealed no etiology. However, she developed stridor, which prompted further evaluation. Laryngoscopy and imaging studies revealed no gross abnormalities; therefore, her symptoms of dysphonia and difficulty breathing were attributed to anxiety. Her hospital course was complicated by a cardiac arrest requiring intubation. ECHO, CTA chest, and MRI brain were unremarkable. Her cardiac arrest was hypothesized as being secondary to laryngeal spasm. During her ICU course, she failed extubation multiple times due to acute respiratory failure. An autoimmune etiology was suspected, prompting a paraneoplastic screen, which revealed elevated levels of AChR antibodies at 124 mmol/L. MG was diagnosed and treatment with plasmapheresis and steroids was initiated. However, complications of thrombocytopenia, anemia, and ARDS ensued, so MG treatment was discontinued. The patient was eventually transferred to a LTACH. Thereafter, at outpatient followup, her MG was treated with mycophenolate and prednisone, which led to significant symptom improvement. Conclusions: MG commonly presents in the third decade with clinical features of ptosis, diplopia, and facial weakness. However, initial and isolated symptoms of dysphagia and dysphonia are rare, leading to missed diagnoses. Our case of a middle-aged woman posed a diagnostic challenge because of her uncommon presentation and comorbidities of panic attacks and obesity. This case highlights the crucial need for a high index of clinical suspicion for MG in any patient presenting with symptoms of CN IX and X weakness.
机译：患者：女性，51岁的最终诊断：肌肌无力症状：障碍？声音嘶哑药物： - 临床手术： - 专业：关键护理药物？神经病学？肺部目标：挑战性鉴别诊断背景：肌肌肌无力（MG）是一种自身免疫性疾病，其特征在于抗体结合骨骼肌乙酰胆碱受体（ACHR）。很少疾病表现出在眼睑前的髋关节症状。我们提出了一个误认为初始介绍的案例有颅神经（CN）IX和X弱点的症状，包括吞咽困难和障碍。案例报告：一个51岁的女性，恐慌袭击呈现给急诊部门（ED），抱怨她的喉咙关闭，吞咽困难和嘶哑的声音。多种ED访问显示没有病因。然而，她开发了浮步，提示进一步评估。喉镜检查和成像研究显示没有总体异常;因此，她的呼吸困难和呼吸困难的症状归因于焦虑。她的医院课程对需要插管的心脏骤停很复杂。回声，CTA胸部和MRI大脑不起眼。她的心脏骤停被假设为继发于喉部痉挛。在她的ICU课程中，由于急性呼吸衰竭，她多次拔管失败。怀疑自身免疫病因，提示致癌膜，其揭示了124mmol / L的ACHR抗体水平升高。 Mg被诊断出患者并用血浆丸剂和类固醇进行治疗。然而，随后发生了血小板，血症和ARDS的并发症，因此停止了MG治疗。患者最终转移到LTACH。此后，在门诊随访中，她的Mg用霉酚酸酯和泼尼松治疗，导致了显着的症状改善。结论：MG常设在第三十年中，具有皮层，复源性和面部弱点的临床特征。然而，吞咽困难和呼吸困难的初始和孤立症状是罕见的，导致错过诊断。由于她的罕见展示和肥胖症，我们的中年女子的案例提出了诊断挑战。这种情况强调了在任何患者患有CN IX和x虚弱的症状中，在任何患者中对MG的高指数的关键需要。

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