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Myasthenia gravis

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Carlos Rene Espino de la Cueva
Carlos Rene Espino de la Cueva
Salud y medicina
1 de 43
Myasthenia Gravis By Robert R. Zaid Medical Student III February 19, 2004
Outline ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Background ,[object Object],[object Object],[object Object],[object Object],[object Object]
Anatomy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Anatomy ,[object Object],[object Object],[object Object],[object Object]
Pathophysiology ,[object Object],[object Object],[object Object],[object Object],[object Object]
Pathophysiology ,[object Object],[object Object],[object Object],[object Object]
Pathophysiology ,[object Object],[object Object]
Epidemiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical Presentation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical presentation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical presentation ,[object Object],[object Object],[object Object],[object Object]
Clinical presentation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical presentation ,[object Object],[object Object],[object Object]
Clinical presentation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical presentation ,[object Object],[object Object],Upper Extremities Deltoids Wrist extensors Finger extensors Triceps > Biceps Lower Extremities Hip flexors (most common) Quadriceps Hamstrings Foot dorsiflexors Plantar flexors
Clinical presentation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical presentation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical presentation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical presentation ,[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical presentation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Differentials ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Work-up ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Work-up ,[object Object],[object Object],[object Object],[object Object]
Work-up ,[object Object],[object Object],[object Object],[object Object],[object Object]
Work-up ,[object Object],[object Object],[object Object],[object Object]
Electrodiagnostic studies: Repetitive Nerve Stimulation ,[object Object],[object Object],[object Object]
Electrodiagnostic studies: Repetitive Nerve Stimulation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Repetitive nerve stimulation ,[object Object],[object Object],[object Object],[object Object],[object Object]
Electrodiagnostic studies: Single-fiber electromyography ,[object Object],[object Object],[object Object],[object Object],[object Object]
Electrodiagnostic studies: Single-fiber electromyography ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Workup Pharmacological testing ,[object Object],[object Object],[object Object],[object Object],[object Object]
Workup Pharmacological testing Before After
Workup Pharmacological testing ,[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment Behavioral modifications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Complications of MG ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Prognosis ,[object Object],[object Object],[object Object],[object Object]
Rehabilitation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
References ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]

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Myasthenia gravis

  • 1. Myasthenia Gravis By Robert R. Zaid Medical Student III February 19, 2004
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Notas del editor

  1. Induciton of a myasthenic-like syndrome in mice by injecting a large quantitiy of immunoglobulin G from MG patients
  2. Induciton of a myasthenic-like syndrome in mice by injecting a large quantitiy of immunoglobulin G from MG patients Top photo shows a rabbit with "floppy" ears after an injection of receptor antigens. Bottom shows the same rabbit after receiving edrophonium. http://www.aneuroa.org/html/c20html/1970_1979.htm
  3. Induciton of a myasthenic-like syndrome in mice by injecting a large quantitiy of immunoglobulin G from MG patients
  4. Onset from mild to maximal weakness is less than 36 months in 83% of patients
  5. Lambert-Eaton myasthenic syndrome (LEMS) is a rare condition in which weakness results from an abnormality of acetylcholine (ACh) release at the neuromuscular junction. Recent work demonstrates that LEMS results from an autoimmune attack against voltage-gated calcium channels (VGCC) on the presynaptic motor nerve terminal.
  6. Positive RNS test features Decrement in CMAP amplitude Size: More than 10% in reduction in CMAP amplitude Measure from 1st to 4th or 5th potential in train Smallest CMAP is often 2nd or 3rd potential in train Post-exercise exhaustion Exercising muscle briefly before testing exacerbates decremental response Occurs rapidly after initial stimulation Post-tetanic potentiation Reduction in decrement in minutes after exercise Occurs after post-exercise exhaustion
  7. Look up D’alessandro