Pérez-Nellar J, Rodríguez A
Servicio de Neurología, Hospital Hermanos Ameijeiras, La Habana, Cuba.
Rev Neurol. 2000;30(8):712-5.
Myasthenia gravis is an uncommon disorder with very variable clinical findings. This often leads to errors in diagnosis.
To study the main errors leading to false negatives in the diagnosis of myasthenia gravis.
We carried out a questionnaire to determine all the doctors and diagnoses made by them in relation to symptoms of myasthenia graves in 109 patients in whom this diagnosis was later confirmed when a specialist was consulted.
Most of the patients went to a general practitioner first. During this initial consultation the disease was only diagnosed in 10 cases (9.2%) and neurosis was the most frequent diagnosis (27.5%). Although most patients had to see from two to four doctors before diagnosis was made, there was no major delay in this. In 84 of the 109 cases the diagnosis was established within the first six months, generally by a neurologist (86.2%) and less frequently by a general physician (11.0%).
General practitioners, ophthalmologists, psychiatrists and otorhinolaryngologists are often involved in the evaluation of these cases although they made little contribution to the diagnosis.
重症肌无力是一种临床症状差异很大的罕见疾病。这常常导致诊断失误。
研究导致重症肌无力诊断假阴性的主要失误。
我们开展了一项问卷调查，以确定109例患者的所有医生及其针对重症肌无力症状所做出的诊断，这些患者后来经专科医生会诊确诊为此病。
大多数患者首先就诊于全科医生。在初次会诊期间，仅10例（9.2%）被诊断为此病，最常见的诊断是神经症（27.5%）。尽管大多数患者在确诊前需看两至四位医生，但并未出现重大延误。109例中的84例在头六个月内确诊，通常由神经科医生确诊（86.2%），较少由全科医生确诊（11.0%）。
全科医生、眼科医生、精神科医生和耳鼻喉科医生常参与这些病例的评估，但他们对诊断贡献不大。
