Emergency Medicine Cases - By Antón Helman - June 01, 2021
“Take home points for neuromuscular disease for emergency medicine
- Guillain-Barre syndrome is an acute, ascending, symmetric and progressive peripheral neuropathy
- The hallmarks of Guillain-Barre syndrome are areflexia and an ascending symmetric pattern of weakness
- Many patients with Guillain-Barre syndrome report a preceding viral-like illnesses, but this is not necessary for the diagnosis
- Tick paralysis differs from Guillain-Barre syndrome in that there is a prodrome of ataxia and irritability prior to the loss of power, and that it occurs in the spring and summer months in tick-endemic areas
- Transverse myelitis differs from Guillain Barre syndrome in that urinary dysfunction is typical of the former
- Myasthenia gravis is a postsynaptic autoimmune disorder of young woman and older men characterized by a descending loss in motor power, typically presenting with bulbar symptoms that are fatigable and fluctuate, hence patients may present when symptoms and signs are absent
- The provisional diagnosis of myasthenia gravis can be in the ED with the simple ice pack test and upgaze test
- Lambert-Eaton syndrome is a presynaptic autoimmune disorder that is commonly seen in older patients and may be distinguished from myasthenia gravis by paradoxical improvement in symptoms with repeated muscle use”