title: The management and outcome of patients with myasthenia gravis treated acutely in a neurological intensive care unit.
abstract: The management and clinical course of patients with myasthenia gravis admitted to a neurological intensive therapy unit (ITU) over a 66 month period were reviewed. Twenty-seven patients were admitted in myasthenic crisis, eight of whom had multiple admissions. One patient had a cholinergic crisis and a further patient an acute myocardial infarction. A specific aetiological factor precipitating myasthenic crisis was identified in 19 instances: infection (8), reduction in medication (5), menstruation (4), and steroid administration (2). Thirteen patients with crisis had had a previous thymectomy, six with thymoma. Twenty-three out of 35 (66%) patients admitted in crisis required intubation; nine subsequently needed a tracheostomy. Twenty-nine patients received plasma exchange and seven intravenous immunoglobulin. Four patients in myasthenic crisis died in ITU [adult respiratory distress syndrome (1), disseminated intravascular coagulation and cytomegalovirus (CMV) pneumonitis (1), cardiac failure (1) and multiple organ failure (1)]. Appropriate management of myasthenia gravis requires the easy availability of specialised neuro-intensive care facilities. Copyright Rapid Science Ltd
authors.affiliation: Department of Clinical Neurology, Batten Harris Unit, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
authors.initials: JI
authors.lastname: O'Riordan
authors.initials: DH
authors.lastname: Miller
authors.initials: JP
authors.lastname: Mottershead
authors.initials: NP
authors.lastname: Hirsch
authors.initials: RS
authors.lastname: Howard