Tuesday, June 1, 2021

Neuromuscular Disease

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”