| QUIZ: Quick weakening and heavy eyelids *solved* |
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| Monday, 21 December 2009 22:12 |
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Case description: 29 yo female came to a GP suffering from an increased fatigability. She claims that 6 months ago she started having bigger and bigger problems with climbing on the second floor of her house and doing most of activities - "I am just loosing strength, my 3 yo son could beat me at arm wrestling" - the woman said. Furthermore she feels her eyelids are becoming heavy. QUIZ question: What disease comes to your mind? What simple test could reject one serious disease giving the same symptoms? What tests do you suggest? What's the treatment? |
Comments
Tests: I ask her to count from 100 to 0. If it would be MG her speech would become blurred. We could give her Tensilon (10mg) eventually the symptoms should go away.
EMG, anti-AChR antibodies.
Treatment: neostigmine, pirydostygminum , Encorton (Prednisonum), metotrexat (Methotrexatum)
We need to think about other genetic muscle diseases too but first and foremost I would think like x-ray1815.
Patient's age and sex agrees with MG risk group. My other ideas is beginning of SM - MRI and McDonald criteria would be helpful.
Additional question: Is there any poisoning which could give similar symptoms and cause worse prognosis?
But we have to think about it in differential diagnosis :-)
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