Myasthenia Gravis – Cholinergic Crisis — SCE Neurology MCQ

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ModeratePeripheral Neuropathy & NeuromuscularMyasthenia Gravis – Cholinergic CrisisSCE Neurology

A 45-year-old woman with myasthenia gravis on pyridostigmine develops increasing weakness, excessive salivation, abdominal cramps, diarrhoea, miosis, and bradycardia. What is the most likely explanation?

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Correct answer: D — Cholinergic crisis due to pyridostigmine excess

The constellation of worsening weakness with cholinergic signs (excessive secretions, miosis, bradycardia, abdominal cramps, diarrhoea) in a patient on pyridostigmine suggests cholinergic crisis from excessive acetylcholinesterase inhibition. Management includes stopping pyridostigmine and supportive care. A: Myasthenic crisis causes weakness without cholinergic signs. C: Addisonian crisis has different features. D: Botulism causes descending weakness with autonomic dysfunction but not these specific cholinergic features. E: The history of pyridostigmine use makes cholinergic crisis more likely than organophosphate exposure.

Reference: ABN MG Guidelines (2025)