Myasthenic crisis

Introduction Two different crises, myasthenia gravis and cholinergic crisis can occur in children with myasthenia gravis . Myasthenia gravis refers to a severe respiratory insufficiency caused by aggravation of the patient's condition or improper treatment. It often has repeated infection, hyponatremia, dehydration, acidosis or irregular medication history, intramuscular injection. Teng Xilong, the symptoms improved after medication. In recent years, according to ultrastructural studies, the disease is mainly caused by lesions of the postsynaptic membrane acetylcholine receptor (AChR).

Cause

1. In recent years, according to ultrastructural studies, the disease is mainly caused by lesions of the postsynaptic membrane acetylcholine receptor (AChR).

2. Many clinical phenomena are also associated with disorders of the disease and immune mechanisms.

Myasthenia gravis refers to a severe respiratory insufficiency caused by aggravation of the patient's condition or improper treatment caused by respiratory muscle weakness, often with repeated infection, hyponatremia, dehydration, acidosis or irregular medication history.

an examination

Related inspection

Electromyography, closed-cell inner muscle, Tengxilong test

Muscle weakness can occur in all age groups, but most are in the age of 15-35, with a male to female ratio of about 1:2. The onset is slow and insidious, and the multiple insidious attacks are mainly characterized by abnormal skeletal muscles and easy fatigue. The muscle strength is good in the morning, and the symptoms are worse in the afternoon or evening. Most patients involve the extraocular muscles to lift the upper diaphragm. Most susceptible to involvement, as the disease progresses, more extraocular muscles can be involved, and diplopia appears. Finally, the eyeball can be fixed, and the intraocular muscles are generally not tired.

In addition, the medullary innervation muscle, neck muscle, scapular muscle, trunk muscle and upper and lower limb muscles can be involved, speech is too long, the sound is gradually low, the articulation is unclear and nasal, due to the lower jaw, soft jaw and swallowing muscle, intercostal space If the muscles are weak, it can affect chewing and swallowing functions and even difficulty breathing. Temporary relief, remission, recurrence, and deterioration of myasthenia symptoms often alternate to form an important sign of the disease. According to the extent and extent of affected muscles, it is generally divided into eye muscle type, bulbar muscle involvement type and systemic type. There are also a very small number of fulminant onsets that can occur, and within a few days to a few weeks, the medullary muscle weakness and dyspnea can occur, and the types can be combined or transformed. Child-type myasthenia gravis refers to the onset of neonatal to adolescent, except for the individual systemic type, which is mostly limited to the extraocular muscle.

Differential diagnosis

Identification of myasthenia gravis, cholinergic crisis, and rumination crisis. Three types of crisis can be identified by the following methods:

1 Tengxilong test.

2 atropine test.

3 EMG examination.

Cholinergic crisis: Cholinergic crisis is the main manifestation of myasthenia gravis crisis caused by excessive administration of anticholinesterase drugs (such as bromopyridinium). The patient's pupils are shrunk, sweating all over, muscles are beating, bowel sounds are hyperthyroidism, and the symptoms of the intramuscular neostigmatism are aggravated.

Ruminant crisis: It is difficult to distinguish the nature of the crisis and can not be used to stop the drug or increase the dose of the drug to improve symptoms, mostly after long-term treatment with large doses. Muscle weakness can occur in all age groups, but most are in the age of 15-35, with a male to female ratio of about 1:2. The onset is slow and insidious, and the multiple insidious attacks are mainly characterized by abnormal skeletal muscles and easy fatigue. The muscle strength is good in the morning, and the symptoms are worse in the afternoon or evening. Most patients involve the extraocular muscles to lift the upper diaphragm. Most susceptible to involvement, as the disease progresses, more extraocular muscles can be involved, and diplopia appears. Finally, the eyeball can be fixed, and the intraocular muscles are generally not tired. In addition, the medullary innervation muscle, neck muscle, scapular muscle, trunk muscle and upper and lower limb muscles can be involved, speech is too long, the sound is gradually low, the articulation is unclear and nasal, due to the lower jaw, soft jaw and swallowing muscle, intercostal space If the muscles are weak, it can affect chewing and swallowing functions and even difficulty breathing. Temporary relief, remission, recurrence, and deterioration of myasthenia symptoms often alternate to form an important sign of the disease. According to the extent and extent of affected muscles, it is generally divided into eye muscle type, bulbar muscle involvement type and systemic type. There are also a very small number of fulminant onsets that can occur, and within a few days to a few weeks, the medullary muscle weakness and dyspnea can occur, and the types can be combined or transformed. Child-type myasthenia gravis refers to the onset of neonatal to adolescent, except for the individual systemic type, which is mostly limited to the extraocular muscle.

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