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Kulczyński Marcin, Sapko Klaudia, Marciniec Michał. Analysis of two cases of myasthenic crisis. Journal of Education, Health and Sport. 2019;9(8):516-522. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.3381775 http://ojs.ukw.edu.pl/index.php/johs/article/view/7343 The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 1223 (26/01/2017). 1223 Journal of Education, Health and Sport eISSN 2391-8306 7 © The Authors 2019; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 05.08.2019. Revised: 15.08.2019. Accepted: 29.08.2019. Analysis of two cases of myasthenic crisis Marcin Kulczyński*, Klaudia Sapko, Michał Marciniec Chair and Department of Neurology, Medical University of Lublin, Poland *Corresponding author: Marcin Kulczyński ul. dr. K. Jaczewskiego 8 20-954 Lublin, Poland tel. +48817244718 e-mail: mk.marcin.kulczynski@gmail.com ABSTRACT Introduction: Myasthenia gravis is an autoimmune disease of the postsynaptic part of the neuromuscular junction. The disease is chronic, manifesting itself in the fatigue of various muscle groups, and the first manifestation of the disease often affects the muscles that move the eyeball and eyelid, although MG can lead to weakness of any muscle group. In turn, myasthenic crisis is a severe worsening of muscle weakness that often results in the urgent need of mechanical ventilation of the patient, due to the respiratory failure. Case reports: The first patient, 64 years old, female was admitted to the Neurology Department due to breathing difficulties and weakness of the limbs, which suddenly worsened within a dozen of hours before admission. During the stay, steroid therapy was used, as well as six times plasma exchange took place at the Nephrology Department with good treatment tolerance. The dosage of pyridostigmine was also modified, with no adverse effects. During the stay, the patient's condition improved - respiratory disorders resolved, ptosis was significantly withdrawn, and limb muscle tension increased globally. The second patient, aged 67, also female, with a history of myasthenia gravis as well, was admitted to the Neurology Department due to increased fatigue, ptosis, dysphagia, and difficulties in speaking and breathing. Steroid therapy was used, but due to high blood glucose, the steroid dose was reduced and a 2-day cladribine treatment was initiated, with good tolerance. Discussion: Myasthenic crisis is often a life-threatening condition that requires immediate treatment. Steroid therapy, pyridostigmine, IVIG and plasma exchange are standard approaches in myasthenic crisis. Cladribine is not an ordinary approach, but can be beneficial in some patients. Keywords: myasthenia gravis; myasthenic crisis; plasma exchange; cladribine. |
