López-Viñas Laura, Rocío-Martín Esmeralda, Delis-Gómez Salvador, Wix-Ramos Rybel
Clinical Neurophysiology Department, Fundación Jiménez Díaz University Hospital, Madrid, ESP.
Clinical Neurophysiology Department, La Princesa University Hospital, Madrid, ESP.
Cureus. 2021 Mar 14;13(3):e13889. doi: 10.7759/cureus.13889.
Myasthenia gravis is a neuromuscular disease that causes weakness in skeletal muscles because of the presence of acetylcholine receptor antibodies. These antibodies produce a compromise in the end-plate potential, reducing the safety factor for effective synaptic transmission. Clinically, this manifests as muscle weakness and, in severe cases, respiratory failure. There is widespread knowledge about the association between small cell lung carcinoma and Lambert- Eaton myasthenic syndrome, but not with other neuromuscular disorders, such as myasthenia gravis. We present a patient with small cell lung carcinoma who presented weakness affecting the proximal muscles over the last three years, and electromyography findings suggesting myasthenia gravis. After this electrodiagnosis, analytical tests showed an increase in anti-acetylcholine receptor antibodies. Given these findings, we can affirm that neurophysiological tests provide a significant value in diagnosing myasthenia gravis, as anti-acetylcholine receptor antibodies were negative at the moment of the electromyography's performance. Likewise, it is essential to consider a paraneoplastic syndrome in this type of carcinoma.
重症肌无力是一种神经肌肉疾病,由于存在乙酰胆碱受体抗体,导致骨骼肌无力。这些抗体会使终板电位受损,降低有效突触传递的安全系数。临床上,这表现为肌肉无力,严重时会出现呼吸衰竭。关于小细胞肺癌与兰伯特-伊顿肌无力综合征之间的关联已广为人知,但与其他神经肌肉疾病,如重症肌无力并无关联。我们报告一名患有小细胞肺癌的患者,在过去三年中出现近端肌肉无力,肌电图检查结果提示重症肌无力。经过此项电诊断后,分析测试显示抗乙酰胆碱受体抗体增加。鉴于这些发现,我们可以肯定,神经生理学测试在诊断重症肌无力方面具有重要价值,因为在进行肌电图检查时抗乙酰胆碱受体抗体为阴性。同样,对于这类癌症,必须考虑副肿瘤综合征。