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Myasthenic crisis — RCPSC IM MCQ

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HardNeurologyMyasthenic crisisRCPSC IM

A 62-year-old woman with myasthenia gravis develops rapidly worsening dysphagia and dyspnea after pneumonia. She can count to 8 on one breath, negative inspiratory force is -16 cm H2O, and arterial blood gas shows rising PaCO2. Pupils are normal and limb reflexes are preserved. What is the most appropriate management?

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Correct answer: E — Admit to ICU for ventilatory support and treat with IVIG or plasma exchange

Bulbar weakness, low negative inspiratory force and hypercapnia indicate myasthenic crisis. ICU-level respiratory support plus rapid immunotherapy with IVIG or plasma exchange is required.

Reference: Canadian neuromuscular practice; AAN myasthenia guidance