Lin Che-Sheng, Wang Juei-Hsiang, Wang Yen-Ho, Pan Shin-Liang
Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.
J Rehabil Med. 2008 Aug;40(8):684-6. doi: 10.2340/16501977-0222.
Both myasthenia gravis and traumatic spinal cord injury are uncommon disorders and their concurrence is extremely rare. We report here the case of a man with stable myasthenia gravis with spinal cord injury due to a motor vehicle accident. His muscle strength and sensory function in all 4 limbs partially recovered during the initial hospitalization. However, after a later episode of pneumonia and urinary tract infection, muscle strength deteriorated and weakness of the ocular muscles occurred. A relapse of myasthenia gravis was confirmed by the elevated anti-acetylcholine receptor antibody titre. Muscle strength recovered rapidly after control of infection and treatment of myasthenia gravis exacerbation. In this case report, we show that spinal cord injury-related complications, including infection or emotional stress, could trigger a relapse of myasthenia gravis. This highlights the importance of recognizing an exacerbation of myasthenia gravis in spinal cord injury patients with a history of myasthenia gravis, since they are prone to urinary and pulmonary infection. Although exacerbation of myasthenia gravis might prolong hospitalization, the functional outcome of spinal cord injury might not be affected if the exacerbation is diagnosed and treated quickly.
重症肌无力和创伤性脊髓损伤均为罕见疾病，二者并发极为罕见。我们在此报告一例患有稳定型重症肌无力的男性患者，其因机动车事故导致脊髓损伤。在初次住院期间，他四肢的肌力和感觉功能部分恢复。然而，在随后发生肺炎和尿路感染后，肌力恶化且出现眼肌无力。抗乙酰胆碱受体抗体滴度升高证实了重症肌无力复发。感染得到控制且重症肌无力加重情况得到治疗后，肌力迅速恢复。在本病例报告中，我们表明与脊髓损伤相关的并发症，包括感染或情绪应激，可能引发重症肌无力复发。这凸显了识别有重症肌无力病史的脊髓损伤患者中重症肌无力加重情况的重要性，因为他们易发生泌尿系统和肺部感染。虽然重症肌无力加重可能延长住院时间，但如果能迅速诊断并治疗加重情况，脊髓损伤的功能预后可能不受影响。
