Department of Neurology, National Center Hospital of Neurology and Psychiatry, Tokyo, Japan.
Am J Otolaryngol. 2012 Nov-Dec;33(6):758-61. doi: 10.1016/j.amjoto.2012.04.003. Epub 2012 Jun 4.
A 47-year-old woman with dysphagia and ptosis gradually developed dysarthria and muscular weakness. Magnetic resonance imaging, testing for anti-acetylcholine receptor antibodies, edrophonium chloride (EC) test, and electrophysiologic test revealed no abnormalities. A psychogenic reaction was suspected. Four months after disease onset, the patient presented to our hospital. In videofluoroscopic examination of swallowing (VF), there was no aspiration for swallowing of either liquid or soft food. It revealed, however, poor pharyngeal constriction, no epiglottis inversion, repeated swallowing movements, and large amounts of pharyngeal residue. Videofluoroscopic examination of swallowing after an intravenous injection of 10 mg EC showed improvements in all above observations; particularly, it was clear when swallowing soft food. Furthermore, the anti-muscle-specific kinase (MuSK) antibody titer was elevated, and anti-MuSK antibody-positive myasthenia gravis (MuSK-MG) was diagnosed. Thus VF during EC test may be helpful in diagnosing MuSK-MG in patients with dysphagia.
一位 47 岁女性出现吞咽困难和上睑下垂，逐渐出现构音障碍和肌肉无力。磁共振成像、抗乙酰胆碱受体抗体检测、依酚氯铵（EC）试验和电生理检查均未见异常。怀疑为精神性反应。发病 4 个月后，患者就诊于我院。吞咽视频透视检查（VF）显示，液体和软食吞咽均无吸入。然而，存在咽缩肌收缩不良、杓状软骨无反转、反复吞咽动作和大量咽部残留。静脉注射 10mg EC 后行吞咽视频透视检查，上述所有观察结果均有改善；尤其在吞咽软食时更为明显。此外，肌肉特异性激酶（MuSK）抗体滴度升高，诊断为抗 MuSK 抗体阳性重症肌无力（MuSK-MG）。因此，EC 试验期间的 VF 可能有助于诊断吞咽困难患者的 MuSK-MG。
