Breaking Down Myasthenic Crisis

NCJ_cover.jpgBy Eelco F. M. Wijdicks MD, PhD

Myasthenia gravis may not be known to the patient before fulminant worsening of swallowing and breathing occurs. Respiratory weakness has reportedly appeared without prior diagnosis, but the absence of some prior signs is improbable. Myasthenia gravis does not proceed in a steady downhill course; instead, it progresses with stops and starts until, at some point, it requires close monitoring in an intensive care unit. There is a general understanding that myasthenia gravis becomes a “crisis” once airway or respiratory support is needed. Experts in treatment of myasthenia gravis have struggled with the definition of rapid, potentially deadly myasthenic worsening. The late Kermit Osserman, one of the most prominent clinicians with an experience of over 1200 cases, devoted a full chapter to it in his 1958 book Myasthenia Gravis and titled it “crisis” and cemented the different types into medical vernacular [1]. Historical review of these cases allows us to examine the semiotics of the crisis in detail.

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