2009 Jan 20 - Grand Round: Common Practice, Fatal Outcome
2009 CCM Interhospital Meeting
Presenter: Dr LUK Ming Chi (Alice Ho Miu Ling Nethersole Hospital)
Chairman: Dr TAI Kian Bun (Alice Ho Miu Ling Nethersole Hospital)
20 Jan 2009
2009 Jan 20 - Grand Round: Is it Myasthenic Crisis?
CCM Interhospital Meeting on 20 Jan 2009
ABSTRACT OF PRESENTATION AVAILABLE
Presenter: Dr CHAN Yan Fat Alfred (Caritas Medical Centre)
Chairman: Dr Tai Kian Bun (Alice Ho Miu Ling Nethersole Hospital)
Upper photo: Dr CHAN Yan Fat Alfred giving lecture; Lower photo: Dr TAI Kian Bun introducing Dr CHAN Yan Fat Alfred
We presented an 82-year-old woman who had known history of ocular myasthenia gravis (MG) since year 2002. She presented to the casualty for subjective double vision and bilateral upper limb weakness after a week of upper respiratory tract infection. She developed choking and aspiration on the next day of hospitalization, and required endotracheal intubation. In ICU, she was treated as myasthenia crisis using intravenous immunoglobulin (IVIG) at dose of 0.4g/ kg body weight.
However, her serum acetylcholine receptor binding antibody titer was 10.57 (reference <0.45), Tensilon test result was negative, and there was no improvement in limb power with Pyridostigmine (Mestinon). EMG showed no typical decremental change in amplitude on repetitive stimulation. Over the next few days, physical examination showed gradual development of global areflexia. Urgent MRI was arranged to exclude spinal cord pathology, and it showed presence of serpentine intradural extramedullary flow-related signals and flow voids from C5 to T9 levels, compatible with spinal vascular malformation. However, the cord itself had no sign of ischemia or hemorrhages.