Princess Royal Spinal Injuries Unit, Northern General Hospital, Sheffield, UK.
Spinal Cord. 2011 Dec;49(12):1206-7. doi: 10.1038/sc.2010.182. Epub 2010 Dec 21.
Case report.
BACKGROUND/OBJECTIVE: Myasthenia gravis (MG) complicating spinal cord injury (SCI) is extremely rare. We report a patient with SCI developing MG leading to death. There are no similar articles at present on literature search.
A 54-year-old man, paralysed at the T12 level (ASIA A) for 40 years, was admitted for surgical repair of his grade IV sacral pressure sore. During the admission he developed diplopia, fluctuating dysphagia and slurred speech. Elevated anti-acetylcholine receptor antibodies and single fibre electromyography confirmed the diagnosis of MG and pyridostigmine was commenced. His admission was complicated by intermittent episodes of unexplained tachycardia and tachypnoea. He succumbed following cardio respiratory within 6 weeks of admission. Post mortem examination was inconclusive of a definite cause of death. In the presence of SCI, it can be challenging to diagnose MG or its complications like myasthenic and cholinergic crisis.
The case highlights the difficulty in diagnosis and management of MG in persons with SCI.
病例报告。
背景/目的：重症肌无力（MG）合并脊髓损伤（SCI）极为罕见。我们报告了一例 SCI 后发生 MG 导致死亡的病例。目前在文献检索中尚无类似文章。
一名 54 岁男性，因 T12 水平 SCI 瘫痪 40 年，因 IV 级骶骨压疮行手术修复入院。住院期间出现复视、波动性吞咽困难和言语含糊。升高的抗乙酰胆碱受体抗体和单纤维肌电图证实了 MG 的诊断，并开始使用吡啶斯的明。他的入院期间出现间歇性不明原因心动过速和呼吸急促。入院后 6 周内死于心肺衰竭。尸检结果无法确定明确的死亡原因。在 SCI 存在的情况下，诊断 MG 或其并发症（如肌无力和胆碱能危象）具有挑战性。
该病例突出了在 SCI 患者中诊断和管理 MG 的困难。
