Diagnostic challenge: Myasthenia gravis in the emergency department.
OBJECTIVE
To describe an instructive case of neurological disease encountered by a nurse practitioner (NP) student in the emergency department (ED). Characteristics, epidemiology, pathophysiology, diagnostic considerations, and appropriate testing options for myasthenia gravis (MG) are included.


METHODS
Findings from the history, physical examination, and diagnostic testing of a 41-year-old male with neck weakness and pain. Review of published literature about MG.


CONCLUSIONS
MG is a pure motor syndrome characterized by fluctuating muscle weakness and fatigue and is exacerbated by sustained muscle use. It is usually caused by an autoimmune process that is chronic and progressive. Multiple patient encounters with the healthcare system often occur prior to diagnosis. Many viable treatment options now exist that can enhance quality of life and improve function.


CONCLUSIONS
The NP must include MG in the differential diagnosis with any report of fluctuating muscle weakness or other neurological, upper gastrointestinal, respiratory, or ophthalmic complaint. The key diagnostic finding is a specific muscle weakness that can be reproduced and exacerbated with sustained muscle use. These considerations will lead to earlier diagnosis and treatment.
Abbott
Susan A
SA
Family and Community Nurse Practitioner Program, Husson University, Bangor, Maine, USA. abbott006@hotmail.com
D000328:Adult; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D004636:Emergency Service, Hospital; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D009157:Myasthenia Gravis / Q000175:diagnosis / Q000188:drug therapy / Q000451:nursing*; D009722:Nurse Practitioners; D011241:Prednisone / Q000627:therapeutic use; D011729:Pyridostigmine Bromide / Q000627:therapeutic use; D013934:Thymectomy
D002800:Cholinesterase Inhibitors; D005938:Glucocorticoids; D011729:Pyridostigmine Bromide; D011241:Prednisone