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一名72岁男性的单侧上睑下垂:使用冰敷试验早期诊断重症肌无力

Unilateral Ptosis in a 72-Year-Old Male: Early Diagnosis of Myasthenia Gravis Using the Ice Pack Test.

作者信息

Conceição Paulo, Gonçalves Renato, Reinas Ana

机构信息

Internal Medicine, Centro Hospitalar Universitário de Santo António, Porto, PRT.

Internal Medicine, Unidade Local de Saúde da Cova da Beira, Porto, PRT.

出版信息

Cureus. 2024 Nov 13;16(11):e73581. doi: 10.7759/cureus.73581. eCollection 2024 Nov.

DOI:10.7759/cureus.73581
PMID:39677121
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11645178/
Abstract

Ptosis, or eyelid drooping, can be an early indicator of various neurological and muscular disorders, underscoring the need for accurate diagnosis to ensure proper management. Myasthenia gravis (MG), a neuromuscular disorder, may initially present with isolated ocular symptoms, often resulting in diagnostic delays. This report details the case of a 72-year-old male who presented to the emergency department with a two-week history of progressive unilateral ptosis. A neurological examination, paired with the "ice pack test" - a simple, noninvasive bedside technique - supported the diagnosis of MG. The test improves neuromuscular transmission through cold application, temporarily alleviating symptoms. Early diagnosis using accessible techniques like the ice pack test can facilitate timely intervention, enhancing patient outcomes. This case emphasizes the value of such methods in identifying MG in patients with isolated ocular manifestations.

摘要

上睑下垂,即眼睑下垂,可能是各种神经和肌肉疾病的早期指标,这凸显了准确诊断以确保妥善管理的必要性。重症肌无力(MG)是一种神经肌肉疾病,最初可能仅表现为眼部症状,常常导致诊断延误。本报告详细介绍了一名72岁男性的病例,该患者因进行性单侧上睑下垂两周而就诊于急诊科。神经系统检查,结合“冰袋试验”——一种简单的非侵入性床边技术——支持了重症肌无力的诊断。该试验通过冷敷改善神经肌肉传递,暂时缓解症状。使用冰袋试验等可及技术进行早期诊断能够促进及时干预,改善患者预后。该病例强调了此类方法在识别有孤立眼部表现患者的重症肌无力方面的价值。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e54f/11645178/b13056e509e4/cureus-0016-00000073581-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e54f/11645178/b13056e509e4/cureus-0016-00000073581-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e54f/11645178/b13056e509e4/cureus-0016-00000073581-i01.jpg

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本文引用的文献

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The Icepack Test in the Diagnosis of Myasthenia Gravis with Ocular Features: A Systematic Review of Diagnostic Accuracy, Technique, and Economic Utility.《以眼部表现为特征的重症肌无力的冰袋试验:诊断准确性、技术和经济学效用的系统评价》。
Semin Ophthalmol. 2023 Oct;38(7):679-685. doi: 10.1080/08820538.2023.2194984. Epub 2023 Mar 26.
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Myasthenia Gravis: Epidemiology, Pathophysiology and Clinical Manifestations.重症肌无力:流行病学、病理生理学及临床表现
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Ice pack test in myasthenia gravis: a cool investigation at the bedside.
重症肌无力的冰敷试验:一项床边的很酷的检查
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Myasthenia Gravis with Elderly Onset at Advanced Age.老年起病的重症肌无力
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Accuracy of the ice test in the diagnosis of myasthenic ptosis.冰试验在诊断重症肌无力性上睑下垂中的准确性。
Neurol India. 2016 Nov-Dec;64(6):1169-1172. doi: 10.4103/0028-3886.193780.
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