title: Myasthenia gravis: lessons for the emergency physician.
abstract: We describe three patients with myasthenia gravis who presented to the emergency department - one with a previously established diagnosis and two others who were newly diagnosed as a result of workup initiated in the emergency department. Differential diagnosis of conditions causing neuromuscular weakness is broad; however, a key aspect of myasthenia gravis is fluctuating muscle weakness that increases with repeated use and improves with rest. Both newly diagnosed patients presented with ocular complaints, a common finding in myasthenia gravis. The third patient presented with a potentially life-threatening myasthenic crisis. Key points of discussion include: bedside tests to diagnose myasthenia gravis; distinction between cholinergic versus myasthenic crisis; and emergency department considerations when intubating a myasthenia gravis patient becomes necessary.
authors.affiliation: Department of Emergency Medicine, Beth Israel-Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: Peter B
authors.initials: PB
authors.lastname: Smulowitz
authors.forename: Julie
authors.initials: J
authors.lastname: Zeller
authors.forename: Leon D
authors.initials: LD
authors.lastname: Sanchez
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Edlow
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D004635:Emergency Medicine; D005260:Female; D006801:Humans; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*