Myasthenic Crisis

This health problem requires urgent intubation procedure or to postpone an extubation procedure after a surgery is done to the patient. The developing weakness noted in the respiratory muscles is the main causative factor in the development of respiratory failure.

The health team taking care of the patient with myasthenic crisis has to initiate intubation as well as mechanical ventilation in instances where manifestations of severe dysphagia associated with some aspiration are assessed; or in cases where an obstruction of the upper airway happens with difficulty of breathing.

These clinical features are usually observed among patients who are experiencing respiratory muscle weakness and a severe muscle weakness of the oropharyngeal airway.

Signs and Symptoms of Myasthenic Crisis

Myasthenic crisis is a threatening health crisis that represents a very severe form of another problem called myasthenia gravis, when the person’s respiratory muscles used for breathing are compromised and becomes weak to function effectively for breathing purposes leading to a respiratory failure.

The existing situation arises when myasthenia gravis will worsen. Myasthenia gravis is known to be a neuromuscular problem that results to some fatigue and muscle weakness in the person due to acetylcholine receptors which are being blocked by certain antibodies at a neuromuscular junction, which can be inherited and present at birth.

The following risk factors can cause Myasthenic Crisis in a person:

• Presence of a thyroid disease
• Regular monthly periods or existing pregnancy among women
• Some changes in medicines taken
• Presence of cough, colds, fever in cases of pneumonia
• Thymus tumor
• Stress resulting from traumatic experiences, emotional upset or surgical procedures
• Aspiration pneumonitis when a person breathes in some stomach acid or vomiting
• Use of contrast dyes during some imaging diagnostic tests such as in magnetic resonance imaging or in CT scanning

It has been noted that there is a worsening problem which develops out of myasthenia gravis during a myasthenic crisis situation. The following signs and symptoms can be present upon assessment:

• Having morning headaches or feelings of fatigue at daytime
• Inability to have adequate rest and sleep at nighttime
• Having a weak tongue and some problems with swallowing and chewing food
• Presence of unhealthy weight loss
• Non-productive weak cough, with more secretions or having the problem to clear out secretions from the airways
• Having some difficulty with speaking and breathing
• Some pulling noted when a person tries to breath at the skin located between the ribs, around the neck and on the abdominal area

Treatment

The diagnosis of myasthenic crisis can be confirmed through the following procedures such as chest X-rays, MRI, arterial blood gas analysis, CT scan and pulmonary function tests.

Myasthenic crisis is a medical emergency which needs immediate interventions among members of the health team when it happens. The primary treatment goal is to ease the breathing of a person to make it better by making the respiratory muscles stronger. It is specifically directed at preventing the lungs from failing in the presence of a crisis health problem.

Treatment may include the following upon the confirmation of a diagnosis of myasthenic crisis:

• Procedures to support breathing – These are the initiation of endotracheal intubation, suctioning of secretions and provision of bilevel positive airway pressure.
• Use of medicines such as immunosuppressives, anticholinestrase agents and immune globulins.
• Administration of intravenous fluids to prevent low blood pressure.
• Use of plasma exchange by receiving plasma from a donor after removal of own blood plasma.

Myasthenic Vs cholinergic Crisis

References:

1. http://www.uptodate.com/contents/myasthenic-crisis
2. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3726100/
3. http://www.drugs.com/cg/myasthenic-crisis.html
4. Engel AG (3 April 2012). Myasthenia Gravis and Myasthenic Disorders (2nd ed.). Oxford University Press, USA. pp. 109–110.
5. Marx, John A. Marx (2014). Rosen’s emergency medicine : concepts and clinical practice (8th ed.). Philadelphia, PA: Elsevier/Saunders. pp. 1441–1444.
6. Uel VC (2004). “Myasthenia gravis: management of myasthenic crisis and perioperative care”. Semin Neurol 24 (1): 75–81.
7. http://www.slideshare.net/narenthorn/acute-peripheral-neurologic-disorder-presentation