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Apr 22

S&W MR 4/19 Myasthenia Gravis

Good News, Everyone!

On Tuesday, we discussed the case of new onset seronegative (AChR negative, MuSK R negative) myasthenia gravis presenting with profound bulbar dysfunction and respiratory failure.  As a take home, objective measurement of respiratory muscle function is essential during your assessment.

VC: Measurements at or below 15-20ml/kg should prompt consideration of elective intubation.

MIP (AKA negative inspiratory force [NIF]): A measurement more positive than -60cmH2O is usually associated with weak coughs.  A measurement more positive than -30cmH2O predicits severe respiratory muscle weakness and should raise suspicion for hypercapnea.

 

For further reading, please see the articles from the Association or British Neurologists and the American Academy of Neurologists below:

Association of British Neurologists Myasthenia Gravis Management Guidelines 2015

AAN Evidence Based Guidelines Plasmapheresis in Neurologic Disorders

AAN Evidence Based Guidelines IVIG in the Treatment of Neuromuscular Disorders

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