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6 results

  • Case 33 - Drug-Induced Myasthenia Gravis: Immune Checkpoint Inhibitor (ICI)-Related

  • from Disorders of the Neuromuscular Junction
  • Jessica E. Hoogendijk, University Medical Center Utrecht, Marianne de Visser, Amsterdam University Medical Center, Pieter A. van Doorn, Erasmus MC, University Medical Center, Rotterdam, Erik H. Niks, Leiden University Medical Center
  • Book:
    Neuromuscular Disease
    Published online:
    29 November 2024
    Print publication:
    19 December 2024, pp 163-164

  • Summary

    A 73-year-old man was referred by his oncologist because of dyspnoea occurring for one and a half weeks, and high CK levels (1341 U/L). For four years he was treated for a melanoma with pulmonary and cerebral metastases. Treatment included nivolumab that had been started three months previously. The dyspnoea was worse on exertion and when lying down. He also experienced some difficulties speaking clearly, and choking had occurred a few times during the past week. He had no diplopia. The complaints did not fluctuate. There was some recent myalgia, but he had not noticed any muscle weakness.

Neuromuscular Disease
  • A Case-Based Approach
  • 2nd edition
  • Jessica E. Hoogendijk, Marianne de Visser, Pieter A. van Doorn, Erik H. Niks
  • Published online:
    29 November 2024
    Print publication:
    19 December 2024
  • There are over 800 neuromuscular disorders and this can leave clinicians feeling lost as they try to diagnose and manage patients. On the basis of 66 adult and paediatric neuromuscular case vignettes, readers will be walked through using case histories and clinical manifestations as a starting point for diagnosis. For each case, diagnostic tools, disease pathogenesis, prognosis and treatment options are discussed. Symptoms, signs and syndromes are cross-linked to help the reader navigate the array of disorders. Accompanying tables explain differential diagnoses and 30 videos demonstrate clinical features. This second edition has been thoroughly updated as the neuromuscular subspecialty has developed from clinically and pathologically descriptive to making use of new diagnostic technologies and therapies. Neurologists at all levels, paediatricians, internists, geneticists, rehabilitation physicians, physiotherapists and researchers in the field will find this an invaluable guide, as they seek to familiarise themselves with this complex range of disorders.

  • Myasthenia and bipolar disorder: a case report and review of literature

  • B. Emna, R. Kammoun, M. Kroui, F. Ellouz
  • Journal:
    European Psychiatry / Volume 65 / Issue S1 / June 2022
    Published online by Cambridge University Press:
    01 September 2022, pp. S455-S456
    • Article
      • You have access
      • Open access
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  • Introduction

    The association between somatic diseases and bipolar disorder (BD) have been described especially for auto-immune diseases.

    Objectives

    Through a case study and a review of literature we are going to describe a comorbidity of BD and myasthenia.

    Methods

    Starting from a case report, we conducted a literature review on “PubMed”, using a key word “myasthenia and bipolar disorder”

    Results

    The patient AJ, 57 years old, married, mother of 5 children; 4 sons and 1 daughter who also has BD. She is illiterate and a full-time mother. she has high blood pressure, a congestive gastropathy and hemorrhoids. She has been diagnosed with BD in 1987 (at 21 years old) and mainly had depressive episodes. She was put on Amitriptyline, carbamazepine, long-acting neuroleptics and benzodiazepines. Since 2006 the patient has been reporting persisting myasthenia even when she was euthymic. In 2009, she was hospitalized for persistent headaches, pain and a decrease in visual acuity in the right eye. An ophthalmoscopy, a cranial CT-scan and an MRI were performed with no anomalies. Then a fluctuant ptosis and an intense fatigability appeared. She then was hospitalized in a neurology ward where she was diagnosed with myasthenia. Changes in her treatment had to be made. Carbamazepine was switched to valproic acid, amitriptyline was switched to fluoxetine. And benzodiazepines were stopped.

    Conclusions

    It’s important to pay close attention to somatic diseases in our patients in order to insure appropriate medical care. Also, the association between somatic disorders and BD can be an interesting lead in elucidating the etiopathogeneses of BD.

    Disclosure

    No significant relationships.

  • 3.4.7 - Neuromuscular Disorders

  • from Section 3.4 - Neurological Impairment and Injury
  • Edited by Ned Gilbert-Kawai, The Royal Liverpool Hospital, Debashish Dutta, Princess Alexandra Hospital NHS Trust, Harlow, Carl Waldmann, Royal Berkshire Hospital, Reading
  • Book:
    Intensive Care Medicine
    Published online:
    27 July 2023
    Print publication:
    01 December 2021, pp 197-200

  • Summary

    Key Learning Points

    1. 1. Several conditions exist that may lead to profound muscle weakness and death.

    2. 2. The most common conditions leading to admission to the ICU are Guillain–Barré syndrome and myasthenia gravis.

    3. 3. Early identification and supportive care can be lifesaving.

    4. 4. Specific therapies initiated in a timely manner can improve the prognosis significantly.

    5. 5. ICU-acquired weakness should be considered in ICU patients with flaccid, generalised weakness or weaning difficulties.

  • Chapter 12 - Perioperative neurological disorders

  • Edited by S. Andrew Josephson, University of California, San Francisco, W. David Freeman, David J. Likosky
  • Book:
    Neurohospitalist Medicine
    Published online:
    07 October 2011
    Print publication:
    29 September 2011, pp 159-174

  • Summary

    Neuromuscular diseases include disorders of anterior horn cells, anterior and posterior roots, plexus, peripheral nerves, neuromuscular junctions, and muscles. Detailed history and physical examination most often provide reliable information to localize the neuromuscular disorder. Motor neuron diseases have in common the dysfunction of the superior or inferior motor neuron. Immune myasthenia gravis is caused by autoantibodies interfering with the normal neuromuscular transmission. Most myopathies are slowly progressing diseases involving predominantly proximal muscles. Corticosteroids are the first-line immunosuppressive treatment in most chronic immune-mediated neuromuscular diseases. Neurological disorders may cause respiratory failure by impairing pulmonary ventilation. For normal ventilation to occur, multiple central and peripheral nervous system structures need to be intact. Respiratory management of neuromuscular respiratory failure requires differentiating between slowly developing conditions in which respiratory failure occurs as an exacerbation of a chronic condition, and rapidly progressive diseases.