Myasthenia Gravis – Case Report and Brief Review of the Literature

Abstract:
Myasthenia gravis is a rare autoimmune neuromuscular junction disease. It is characterized by fluctuating skeletal muscle weakness, which worse during repetitive activities and improve with rest. There is a bimodal distribution to the age of onset with an early peak in the second and third decades of life in women and a late peak in the sixth to eighth decades in men. This paper described a case of a 57-year-old male patient, who was admitted to the Department of Neurology due to left eyelid drooping, left ear hearing loss, lower left mouth corner, speech and swallowing disorders, dizziness and memory impairment. These disorders have appeared about two weeks ago, intensified during the day and after exercise. In the interview, the patient informed about resection of mediastinal tumor – thymoma. Differential diagnosis included stroke, peripheral facial nerve injury, myasthenia gravis and myasthenic syndromes. Neuroimaging did not show any significant pathologies. In electromyography features of myogenic signal were observed. The titer of antibodies against the acetylcholine receptor was elevated. Based on clinical signs and diagnostic tests, myasthenia gravis was diagnosed. The patient, treated with pyridostigmine bromide, get an improvement in neurological status. In conclusion, diagnosis of myasthenia gravis in its early stages may cause diagnostic difficulties. In symptomatic treatment cholinesterase inhibitors and immunosuppressants are used. About 5% of patients die from myasthenic crisis. An important element of medical care is the education of the patients and their families.

Authors:
Aleksandra Marzeda, Joanna Szkatula, Veronique Petit, Konrad Rejdak

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