Acute Medicine Unit, Epsom General Hospital, Dorking Rd, Epsom, KT18 7EG, UK.
Epsom General Hospital, Dorking Rd, Epsom, KT18 7EG, UK.
J Med Case Rep. 2024 Jul 4;18(1):319. doi: 10.1186/s13256-024-04617-w.
Myasthenic crisis (MC) is a life-threatening complication of myasthenia gravis (MG), necessitating ventilation. Achieving a safe and timely diagnosis of myasthenic crisis with atypical, isolated presentation is a considerable challenge particularly in elderly patients, where myasthenia gravis can present with isolated dysarthria in rare instances, giving a clinical impression of lacunar stroke.
We present a compelling case of a 73-year-old Caucasian female presenting with abrupt onset of isolated dysarthria. Despite initial treatment for a presumed lacunar stroke, subsequent evaluations led to her diagnosis of a myasthenic crisis. Within 72 h of admission, the patient developed dysphagia and shortness of breath, requiring supplemental oxygen. The case highlights the sequential progression of events from the atypical presentation of isolated dysarthria and its course to the management of a myasthenic crisis.
Our reported case focuses on the discussion of myasthenia that mimicked a lacunar stroke and was finally diagnosed at a critical time of medical crisis. This case highlights the imperative notion that isolated dysarthria in elderly individuals warrants vigilant monitoring for possible myasthenia gravis, given the low incidence of lacunar stroke presenting with only dysarthria.
肌无力危象(MC)是重症肌无力(MG)的一种危及生命的并发症,需要进行通气。对于表现不典型、孤立的肌无力危象,实现安全、及时的诊断是一项巨大的挑战,尤其是在老年患者中,MG 罕见情况下可仅表现为孤立性构音障碍,给人以腔隙性卒中的临床印象。
我们呈现了一个引人注目的病例,一名 73 岁的白人女性突发孤立性构音障碍。尽管最初被诊断为疑似腔隙性卒中进行了治疗,但随后的评估导致她被诊断为肌无力危象。入院后 72 小时内,患者出现吞咽困难和呼吸急促,需要补充氧气。该病例强调了从孤立性构音障碍的非典型表现及其进展到肌无力危象的管理的一系列事件的顺序。
我们报告的病例重点讨论了肌无力的表现类似于腔隙性卒中,最终在医疗危机的关键时刻得到了诊断。该病例突出表明,老年人孤立性构音障碍需要警惕可能的重症肌无力,因为腔隙性卒中仅表现为构音障碍的发生率较低。