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Myasthenic crisis — ABIM Board MCQ

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HardNeurologyMyasthenic crisisABIM Board

A 31-year-old with antibody-positive myasthenia gravis develops dysphagia and dyspnea. Forced vital capacity is 12 mL/kg and negative inspiratory force is -18 cm H2O. She is alert but cough is weak. Which management is indicated?

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Correct answer: B — Admit to ICU for airway planning and rapid immunomodulation

The best answer is “Admit to ICU for airway planning and rapid immunomodulation”. This is impending myasthenic crisis with severe respiratory weakness and bulbar dysfunction. ICU care, serial respiratory assessment, early airway planning and rapid therapy with IVIG or plasma exchange are required. Pyridostigmine escalation does not reverse crisis, magnesium worsens neuromuscular transmission, and thymectomy is not an emergency bedside treatment.

Reference: International Consensus Guidance for Management of Myasthenia Gravis: https://pmc.ncbi.nlm.nih.gov/articles/PMC7884987/