PATIENT PRESENTATION:

62 yr old female, K.W. with an insignificant PMHx, presents to the to the ED with complaints of progressive weakness/fatigue for 6 weeks that is worse in the afternoon, difficulty keeping eyes open, trouble with her gait, and now complains of difficulty breathing.   She is intubated for airway protection and is admitted to the Neuro Surgical Intensive Care Unit.

DIFFERENTIAL LIST:

Guillian Barre

Botulism

Myasthenia Gravis

LABS & TESTS:

Labs:

Na+ 136          K+ 3.8

WBC 10          HCT 38           HGB 13

Vital Signs:                            

HR: 73                                                BP: 132/67

SpO2: 90% on 6L NC                        RR: 31                                    

Diagnostic Tests:

AchR Antibody blood test – increased

Nerve Conduction Study – decreased

Exam:

Admitting Exam: K.W. is A&O x3, follows commands x4, has 3/5 strength in all extremities, and has bilateral ptosis.  After 3 weeks on your unit, K.W. is now 1/5 strength in all extremities, cannot open her eyes, and now has a tracheostomy.

DIAGNOSIS:

Myasthenia Gravis.

TREATMENT:

Treatment will include IV IG, prednisone PO, and Mestinon PO.

OUTCOME:
Although there is no cure, symptoms can be reduced.  K.W. will need long term steroids and physical therapy.  She will need to be educated to avoid stressful situations, wear an eye patch if she experiences double vision d/t eye muscle weakness, and call 911 if she experiences any respiratory difficulties as this could be a sign of Myasthenic Crisis.

Case created by Kelley Wicheta, 2011.