Myasthenia Gravis Case Study

○ History and physical examination is suggestive of disease by explicit clinical criteria (i.e., hypertension, sudden onset of seizure, neurologic deficits, coma)·

A. In 1994, Karen was diagnosed with Myasthenia Gravis (MG), which is a rare neuromuscular disease. It was understood that this is what she had been

The patient is a 59-year-old right-handed white female who was admitted in June to Portsmouth Regional Hospital for what was determined to be either transient global amnesia or complicated migraine. I did review those notes. She was seen by Galina Simkin, MD. The symptomatology discussed in the H&P is consistent with transient global amnesia. She was having problems asking questions inappropriately, repeating sentences, repeating questions over and over again, and seeming somewhat confused. There were no other neurological symptoms at that time. No evidence for seizure activity. No evidence for stroke. She was brought to the emergency room, where she underwent a CAT scan, which was

No scalp lesions. Dry eyes with conjunctival injection. Mild exophthalmos. Dry nasal mucosa. Marked cracking and bleeding of her lips with erosions of the mucosa. She has a large ulceration of the mucosa at the bite margin on the left. She has some scattered ulcerations on her hard and soft palette. She has difficulty opening her mouth because of pain. Tonsils not enlarged. No visible exudate. SKIN: She has some mild ecchymosis on her skin and some erythema, she has some patches but no obvious skin breakdown. She had some fissuring in the buttocks crease. PULMONARY: Clear to precussion and auscultation, bilaterally. CARDIOVASCULAR: No murmurs or gallops noted. ABDOMEN: Soft, non-tender, protuberant, no organomegaly, and positive bowel sounds. NORALOGIC EXAME: Cranial nerves ii – xii are grossly intact, diffuse hyporeflexia. MUSCULAR SKELETAL: Erosive destructive changes in elbows, wrist, and hands consistent with rheumatoid arthritis. Has had bilateral total knee replacements with stovepipe legs and perimalledal pitting edema 1+. I feel no pulse distally in either leg. PHYCIATRIC: Patient is a little anxious about these new symptoms and there significance. We discussed her situation and I offered her psychiatric services, she refused for now.

You were also seen and evaluated by a neurologist (nerve specialist) to rule out a stroke. Your National Institutes of Health Stroke Scale (scale to estimate if you are having a stroke) score on arrival was (two) 2 and you passed your dysphagia (swallowing) screen. To note: the neurologist did not think that you were experiencing a stroke and recommended a magnetic resonance imaging (test) of your head and neck which can be done in an outpatient setting. Based on the Interqual guideline criteria (a decision based program to determine medical need) for syncope (passing out), the clinical guidelines were not met because there was no palpitations (fluttering in chest) or shortness of breath documented. No Echocardiogram (test) or Orthostatic (blood pressure and heart rate check in sitting and standing position) blood pressure measurements were submitted. A review of your records showed that you could have been placed in observation under close monitoring, had an evaluation, been tested and retested for cardiac (heart) or other event causing the signs and

Patient 1: monitor B/P, pulse, respirations, skin appearance and touch, notable changes in neurologic function, ECG, lab

Patient is a 58-year-old right-hand white male interviewed in the presence of his wife. He was previously seen by me last month for admission for the acute onset of vertigo with possible TIA or stroke as etiology. He stated that he awoke on 06/18/2015 in his usual state of health and then went to work and while there, he had the sudden onset of marked spinning vertigo. He was unable to walk straight, but denied any bilateral lower extremity weakness. He did have nausea and vomited several times. He initially denied any diplopia, visual field cut, blurred vision, facial asymmetry, facial or body sensory changes, dysarthria, or focal weakness. He continued to have marked vertigo in the emergency room,

The patient is an 85-year-old female who is brought to the ED by her family because of increasing confusion and supposedly she had a degree of altered mental status of two hours previous to presentation. In the ED she is completely worked up. CT shows advanced atrophy with microvascular changes and several lacunar infarcts nothing acute. Specific gravity in the urine reveals her to be markedly dehydrated. She culture completely, started on IV antibiotics, IV fluids and B12. On the day after admission she still presents as persistently confused. She is evaluated by PT. The patient who was formerly ambulating with a walker and allegedly driving a car is unable to be ambulated. Before the history indicates that she has a slow downward

Myasthenia Gravis (MG) is a chronic autoimmune disorder of the neuromuscular system part of the body. Chronic means persisting for a long time or constantly recurring. Autoimmune disorder is the confusion of the body’s immune system. The immune system form antibodies that mistakenly identify healthy tissue as foreign and then, the antibodies will attack and/or destroy healthy body tissue. Neuromuscular is the nervous system relationship with the muscles bring about body movement.

Blood pressure -138/88, HR 71, Lung sounds –clear, temperature 98.8 F, radial pulse and pedal pulses +1 bi-laterally, normoactive bowel sounds. No history of smoking, drugs, alcohol use or diabetes; takes no daily medications. Surgical history: Hernia surgery September 2016 and cataract surgery September 2013. Moderately active, walks every day, sometime incorporating hand weights. Patient presents with minimal trembling unilaterally, (left side) when fingers stretched out, reports movements have been slower than normal. Patient’s wife reports “He’s been eating more slowly and it has been taking longer for him to get dressed in the morning.”. Upon examination it was determined that patient has reduced arm swing, slight stiffness in neck, difficulty rising from sitting position in the chair, masked facial features and deteriorated balance. No signs or symptoms of stroke.

Patient S is a seventy-eight-year-old male who presented to the ED in Rushville on October 25th with signs and symptoms of a stroke. These symptoms were leaning to the left side, a left facial droop, weakness in the left arm, and ataxia. The patient has no history of stroke. Patient S was admitted to 4-G in Memorial for a right-sided ischemic stroke. The patient has a history of atrial fibrillation (A-Fib), hyperlipidemia, bleeding problems, hypertension, sleep apnea, and a pacemaker. Patient S lives at home with his wife. Patient S was independent before the stroke. On October 13th, the patient had surgery of lumbar stenosis on L3, L4, and L5. The patient and wife reported increased serosanguinous drainage that soaked the dressing. Patient denied fever or pain at incision site. The doctor decreased Warfarin from 5 milligrams (mg) to 2.5 mg and prescribed a full dose of aspirin.

Today, there are over 12,000 known illnesses in the world; most of these illnesses are more common and are heard of more often than others, but some illnesses are more strange and rare than one may think. In some cases, people may not call their illness an illness because it is way too “bizarre,” and they feel that no one else has the same problem as them. Some of these bizarre illnesses are a lot more common than one would think. Some of these bizarre illnesses may include; Alien Hand Syndrome (AHS), Street Light Interference data exchange syndrome (SLIde), Kleine-Levin Syndrome, Guillian-Barre Syndrome, and Foreign Accent Syndrome (FAS). Each of these illnesses are so bizarre, one probably would not think that having it was even possible.

Myasthenia gravis is a disease that affects voluntary muscles of the body; it causes the weakening of the muscles. In this essay we will talk about how to treat myasthenia gravis, the symptoms and causes

Autonomic dysreflexia is a clinical syndrome that develops in a patient who has neurological damage especially the ones with spinal cord injury (SCI) and develops hypertension. This is brought about by developing a confusing impulse from the bowel or bladder resulting in uncontrolled hypertension in a SCI patient. The SCI must be at the level of the sixth thoracic spine vertebrae (T6) and above for a patient to be at risk of developing dysreflexia. This syndrome develops when there is an imbalance of the autonomic nervous system. The imbalance leads the body in to systemic hypertension that may be life threatening (Robertson & Biaggioni, 2012). Hypertension may be uncontrolled and may result in targeted organ failure hence causing serious complications such as cerebral hemorrhage, myocardial infarction, pulmonary edema, retinal hemorrhage, renal insufficiency, seizures and even death.

Case Study: A thirty six year old male has developed severe muscle weakness throughout the body. The condition began fifteen months ago with a left foot drop and within a year, he described difficulty with speech and swallowing, muscle twitching and cramping, and muscular atrophy throughout the upper and lower limbs. Within the last two months, his breathing has become more difficult, and there has been a noticeable difference in his voice. Prior to the fifteen months, he presented little to no symptoms. The patient, a medical doctor, has a wife and two young children.