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Myasthenic crisis — SCE Acute Medicine MCQ

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EasyNeurology and ophthalmologyMyasthenic crisisSCE Acute Medicine

A 62-year-old woman with myasthenia gravis presents with two days of dysphagia and breathlessness after a chest infection. She has bilateral ptosis, weak neck flexion and a quiet cough. SpO2 is 96% on air, but forced vital capacity is 14 mL/kg and she cannot count beyond 8 in one breath. What is the most appropriate next step in management?

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Correct answer: B — Arrange urgent critical care and neurology review for myasthenic crisis

Myasthenic crisis can present with ventilatory muscle weakness despite normal oxygen saturation until late. Low forced vital capacity, bulbar symptoms and weak cough require urgent critical care and neurology involvement for ventilatory support planning and disease-specific treatment such as IVIG or plasma exchange. Magnesium, beta-blockers and aminoglycosides can worsen neuromuscular transmission and should be avoided where possible.

Reference: Association of British Neurologists Myasthenia Guidance; BNF