Myasthenia gravis

 

Three Types of Myasthenia gravis

  1. Ocular Myasthenia gravis

  • higher prevalence in males

  • muscle weakness confined to the eye

  1. Generalized Myasthenia gravis

  • affects the proximal musculature throughout the body with four different disease progressions

  1. a course with periodic remission

  2. a slow progression course

  3. a rapidly progressive course

  4. a fulminating course

  1. Bulbar myasthenia Myasthenia gravis

  • involves the muscles innervated by the cranial nerves IX, X, XI and XII

  • disease progression is typically rapid or fulminating

Manifestations

  • may present during pregnancy, post-partum or linked to the administration of some anesthetics

  • Fatigue after exercise

  • Hx of upper respiratory tract infections

  • muscles of eyes, face, mouth, throat and neck are affected first

Affected extraoccular muscles of the eye and levator muscles result in (Primarily):

  • diplopia

  • ptosis

  • ocular palsies

Affected muscles controlling facial expression, mastication, swallowing and speech result in (Secondary):

  • facial droop

  • no expressive ability

  • dysphagia

  • dysphasia

  • episodes of choking and aspiration

Muscles of neck, shoulder girdle, and hip girdle are less frequently affected resulting in:

  • pt experiences fatigue

  • periods of rest required

  • pt may have difficulty maintaining head position

  • muscles of diaphragm and chest wall become weakened

  • ventilation may be impaired

  • impairment of deep breathing and cough muscles predispose pt to atelectasis and congestion

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