1
|
Alrmali AE, Saglik B, Sherif I, Wang HL. Complete mouth rehabilitation with fixed implant-supported restoration for a patient with myasthenia gravis: A clinical report. J Prosthet Dent 2023:S0022-3913(23)00363-3. [PMID: 37423788 DOI: 10.1016/j.prosdent.2023.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 07/11/2023]
Abstract
This clinical report describes a complete mouth fixed implant-supported rehabilitation for a patient with myasthenia gravis. Patients with myasthenia gravis may have impaired manual dexterity from progressive neuromuscular impairment. Muscle weakness and fatigue, reduced denture stability, and the inability to provide maxillary dentures with a peripheral seal have compromised the ability to wear dentures. Therefore, care is needed when providing an implant-supported prosthesis. This clinical report provides step-by-step management of a patient with myasthenia gravis, providing a complete arch implant-supported rehabilitation.
Collapse
Affiliation(s)
- Abdusalam E Alrmali
- Graduate student, Department of Periodontics and Oral Medicine, University of Michigan, School of Dentistry, Ann Arbor, Michigan, USA; Lecturer, Department of Oral Pathology, Oral Medicine and Oral & Maxillofacial Surgery, School of Dentistry, University of Tripoli, Tripoli, Libya
| | - Berna Saglik
- Clinical Associate Professor, Department of Biologic Materials and Sciences and Prosthodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Hom-Lay Wang
- Collegiate Professor and Director of Graduate Periodontics, Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Ann Arbor, Michigan, USA..
| |
Collapse
|
2
|
Reddy U, Hagi MA. Neuromuscular disorders: relevance to anaesthesia and intensive care. ANAESTHESIA & INTENSIVE CARE MEDICINE 2023. [DOI: 10.1016/j.mpaic.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
|
3
|
AlManea SM, AlHadlaq MA, AlBuqmi NM, AlGomaiz SS. The Dental Management of Pediatric Patient Diagnosed with Myasthenia Gravis: A Case Report. Eur J Dent 2022; 16:710-714. [PMID: 35728606 PMCID: PMC9507565 DOI: 10.1055/s-0042-1745773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Myasthenia gravis (MG) is a rare autoimmune neurological disorder characterized by muscle weakness and can vary in severity from the mild form that affects the ocular muscles only to the generalized form that affects the other muscle groups. The prevalence of MG is 150 to 200 per million population over the past 50 years, and approximately 10% of these cases are pediatric patients where the disease onset starts before the age of 18 years. The etiology of MG is due to the blockage of neuromuscular transmission by circulating autoantibodies targeting mainly the nicotinic acetylcholine receptor (AChR) and associated proteins in the postsynaptic membrane of skeletal muscles. In MG patients, dental treatment is challenging due to the nature of the condition and its complexity. Moreover, dentists treating MG patients should acquire knowledge about the disease background and the special considerations that need to be taken. In this case report, our aim was to raise awareness about MG among dentists and discuss the dental management of the patients who have this disease and the precautions that should be taken. This case report presents a pediatric MG patient with poor oral hygiene, multiple decayed teeth, dental fluorosis, tongue thrust oral habit that led to anterior open-bite and uncomplicated crown fracture of the upper permanent central incisors. The decision was made to treat the patient under general anesthesia because of the medical condition and the extent of the dental treatment. In the process of preparing the patient for surgery, the patient was cleared from the treating physicians and was admitted under neurology care as per the primary physician. On the day of surgery, the patient received full-mouth dental rehabilitation under general anesthesia, including pulp therapy, crowns, restorations, and extractions. Furthermore, she was seen regularly in recall visits every 3 months.
Collapse
Affiliation(s)
- Saad M AlManea
- Department of Pediatric Dentistry, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Mashael A AlHadlaq
- Department of Pediatric Dentistry, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Noura M AlBuqmi
- Department of Pediatric Dentistry, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Sultan S AlGomaiz
- Department of Dental Services, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| |
Collapse
|
4
|
Genç BGÇ, Orhan K. Odontogenic fibromyxoma: A case report in myasthenia gravis patient and review of the literature. Int J Surg Case Rep 2022; 96:107306. [PMID: 35728373 PMCID: PMC9214793 DOI: 10.1016/j.ijscr.2022.107306] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/09/2022] [Accepted: 06/11/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Odontogenic fibromyxoma is generally slow-growing, benign, asymptomatic, present with painless swelling in the jaw. Pain is mostly seen in the case of infection, adjacent anatomical structures or neural involvement. When the English-language literature is searched, only 62 cases are found about odontogenic fibromxoma which means it is really rare pathology. CASE PRESENTATION We describe a case of odontogenic fibromyxoma in a 29-year-old female with Myasthenia Gravis (MG) who referred to oral and maxillofacial surgeon with increased swelling in the anterior region of the mandible. CLINICAL DISCUSSION Clinically, there was swelling in the mouth that caused bone expansion. On the radiological examination, a well-circumscribed, radiolucent area causing displacement of the tooth roots was observed. After clinical and radiological examinations, the operation was done under local anesthesia. The excised lesion was sent for histopathological investigation and the patient was followed up clinically and radiologically for 3 years. CONCLUSION The clinical and radiological properties, differential diagnosis, treatment options and prognosis of odontogenic fibromyxomas are also discussed after the case presentation along with literature review.
Collapse
Affiliation(s)
- Bedriye Gizem Çelebioğlu Genç
- Department of Oral and Maxillofacial Surgery, Cyprus University of Health and Social Sciences, Morphou, TRNC, Mersin 10 Turkey; Department of Oral and Maxillofacial Surgery, Dr Burhan Nalbantoglu Government Hospital, Nicosia, TRNC, Mersin 10 Turkey.
| | - Kaan Orhan
- Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ankara University, Ankara, Turkey; Ankara University Medical Design Application and Research Center (MEDITAM), Ankara, Turkey
| |
Collapse
|
5
|
Abstract
Surgery and anesthesia carry risks of ischemic, hemorrhagic, hypoxic, and metabolic complications, all of which can result in neurologic symptoms and deficits. Patients with underlying cardiovascular and cerebrovascular risk factors are particularly vulnerable. In this article the authors review the neurologic complications of surgery and anesthesia, with a focus on the role of the neurologic consultant in preoperative evaluation and risk stratification and diagnosis and management of postoperative complications.
Collapse
Affiliation(s)
- Daniel Talmasov
- Department of Neurology, New York University School of Medicine, 222 East 41st Street, 14th Floor, New York, NY 10017, USA
| | - Joshua P Klein
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Room 4018, 60 Fenwood Road, Boston 02115, MA, USA.
| |
Collapse
|
6
|
Krenn M, Grisold A, Wohlfarth P, Rath J, Cetin H, Koneczny I, Zimprich F. Pathomechanisms and Clinical Implications of Myasthenic Syndromes Exacerbated and Induced by Medical Treatments. Front Mol Neurosci 2020; 13:156. [PMID: 32922263 PMCID: PMC7457047 DOI: 10.3389/fnmol.2020.00156] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 07/28/2020] [Indexed: 12/21/2022] Open
Abstract
Myasthenic syndromes are typically characterized by muscle weakness and increased fatigability due to an impaired transmission at the neuromuscular junction (NMJ). Most cases are caused by acquired autoimmune conditions such as myasthenia gravis (MG), typically with antibodies against the acetylcholine receptor (AChR). Different drugs are among the major factors that may complicate pre-existing autoimmune myasthenic conditions by further impairing transmission at the NMJ. Some clinical observations are substantiated by experimental data, indicating that presynaptic, postsynaptic or more complex pathomechanisms at the NMJ may be involved, depending on the individual compound. Most robust data exist for the risks associated with some antibiotics (e.g., aminoglycosides, ketolides, fluoroquinolones) and cardiovascular medications (e.g., class Ia antiarrhythmics, beta blockers). Apart from primarily autoimmune-mediated disorders of the NMJ, de novo myasthenic manifestations may also be triggered by medical treatments that induce an autoimmune reaction. Most notably, there is growing evidence that the immune checkpoint inhibitors (ICI), a modern class of drugs to treat various malignancies, represent a relevant risk factor to develop severe and progressive medication-induced myasthenia via an immune-mediated mechanism. From a clinical perspective, it is of utmost importance for the treating physicians to be aware of such adverse treatment effects and their consequences. In this article, we aim to summarize existing evidence regarding the key molecular and immunological mechanisms as well as the clinical implications of medication-aggravated and medication-induced myasthenic syndromes.
Collapse
Affiliation(s)
- Martin Krenn
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Anna Grisold
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Philipp Wohlfarth
- Division of Blood and Marrow Transplantation, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Jakob Rath
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Hakan Cetin
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Inga Koneczny
- Department of Neurology, Medical University of Vienna, Vienna, Austria.,Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Fritz Zimprich
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
7
|
Exploring Factors Influencing Complete Denture Management of Patient with Myasthenia Gravis. BALKAN JOURNAL OF DENTAL MEDICINE 2020. [DOI: 10.2478/bjdm-2020-0019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Summary
Background/Aim: The purpose of this literature review and case report was to highlight the oral symptoms and the pathophysiology of Myasthenia Gravis (MG). MG is an autoimmune, antibody-mediated neuromuscular disorder. It is characterized by fluctuating fatigability and weakness affecting ocular, bulbar and (proximal) limb skeletal muscles.
Case report: The case of an edentulous 72-year-old female patient with MG, and in need of removable prostheses was reported. The dental management of a complete denture wearer with MG required special attention and treatment protocols, as described in the present case report.
Conclusions: Dental treatment, especially complete denture rehabilitation, of patients diagnosed with MG presents a challenge to the oral health care provider. Clinicians must be aware of the patients’ health status in order to preserve their natural dentition. Implant-supported overdentures must be the treatment of choice in cases of edentulism coupled with MG. In cases where a complete denture is the treatment option, the prosthesis should be placed in the zone of minimum conflict (neutral zone) for optimal neuromuscular coordination.
Collapse
|
8
|
Dahal S, Bhandari N, Dhakal P, Karmacharya RM, Singh AK, Tuladhar SM, Devbhandari M. A case of thymoma in myasthenia gravis: Successful outcome after thymectomy. Int J Surg Case Rep 2019; 65:229-232. [PMID: 31734473 PMCID: PMC6864328 DOI: 10.1016/j.ijscr.2019.10.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 10/23/2019] [Accepted: 10/25/2019] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Thymic abnormalities occur as hyperplasia and thymoma. Myasthenia gravis is commonly present in thymoma. Thymectomy possesses risk due to anatomical proximity with vital thoracic structures and myasthenia crisis. PRESENTATION OF CASE Forty five years female with complaints of difficulty swallowing and weakness of upper limb muscles upon investigation showed mass in mediastinum and antibody test for myasthenia gravis positive. Medical management was done for a month followed by thymectomy. There were no intra and postoperative complications. Medical management was stopped one month after surgery and she is symptom free. DISCUSSION Thymectomy is the standard of care where median sternotomy is the mainstay approach to surgery. Various other surgical approaches and complications revolving around surgery has been discussed. CONCLUSION Surgical removal of thymoma cured myasthenia gravis in our case. We focused on proper preoperative optimization of myasthenia gravis symptoms before thymectomy.
Collapse
Affiliation(s)
- S Dahal
- Kathmandu University School of Medical Sciences, Department of Surgery, Dhulikhel, 3, Nepal.
| | - N Bhandari
- Kathmandu University School of Medical Sciences, Department of Surgery, Dhulikhel, 3, Nepal
| | - P Dhakal
- Kathmandu University School of Medical Sciences, Department of Surgery, Dhulikhel, 3, Nepal
| | - R M Karmacharya
- Kathmandu University School of Medical Sciences, Department of Surgery, Dhulikhel, 3, Nepal
| | - A K Singh
- Kathmandu University School of Medical Sciences, Department of Surgery, Dhulikhel, 3, Nepal
| | - S M Tuladhar
- Kathmandu University School of Medical Sciences, Department of Surgery, Dhulikhel, 3, Nepal
| | - M Devbhandari
- Kathmandu University School of Medical Sciences, Department of Surgery, Dhulikhel, 3, Nepal
| |
Collapse
|
9
|
Ho RYJ, Chern ZRB, Kristanto W. Authors' reply. Singapore Med J 2019; 60:552. [PMID: 31663103 DOI: 10.11622/smedj.2019134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Ren Yi Jonas Ho
- NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | |
Collapse
|
10
|
Prabhu SS, Khan SA, Doudnikoff AL, Reebye UN. Anesthetic considerations for a patient with myasthenia gravis undergoing deep sedation in an outpatient oral surgery setting. J Dent Anesth Pain Med 2019; 19:67-72. [PMID: 30859135 PMCID: PMC6405345 DOI: 10.17245/jdapm.2019.19.1.67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/07/2019] [Accepted: 02/08/2019] [Indexed: 11/15/2022] Open
Abstract
Myasthenia gravis (MG) is a neuromuscular autoimmune disorder which clinically presents as muscular weakness and fatigue due to autoantibody formation against acetylcholine receptors (AChR), leading to their subsequent destruction. Due to the neuromuscular implications of MG, certain considerations must be taken into account when providing anesthesia to MG patients. In the following case report, we have outlined procedural considerations for the anesthetic management of a patient with MG undergoing deep sedation for an elective oral surgery in an outpatient setting, as well as a discussion of relevant literature.
Collapse
Affiliation(s)
- Shamit S Prabhu
- Triangle Implant Center, Durham, NC, USA.,Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | | | | |
Collapse
|
11
|
Cata JP, Lasala JD, Williams W, Mena GE. Myasthenia Gravis and Thymoma Surgery: A Clinical Update for the Cardiothoracic Anesthesiologist. J Cardiothorac Vasc Anesth 2018; 33:2537-2545. [PMID: 30219643 DOI: 10.1053/j.jvca.2018.07.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Indexed: 12/17/2022]
Abstract
Myasthenia gravis (MG) is a rare neuromuscular disorder characterized by skeletal muscle weakness. Patients with MG who have thymoma and thymic hyperplasia have indications for thymectomy. The perioperative care of patients with MG scheduled for thymus resection should be focused on optimizing their neuromuscular function, identifying factors related to postoperative mechanical ventilation, and avoiding of triggers associated with myasthenic or cholinergic crisis. Minimally invasive surgical techniques, use of regional analgesia, and avoidance or judicious administration of neuromuscular blocking drugs (NMBs) is recommended during the perioperative period. If NMBs are used, sugammadex appears to be the drug of choice to restore adequately the neuromuscular transmission. In patients with postoperative myasthenic crisis, plasma exchange or intravenous immune globulin and mechanical support is recommended.
Collapse
Affiliation(s)
- Juan P Cata
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX; Anesthesiology and Surgical Oncology Research Group, Houston, TX.
| | - Javier D Lasala
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX; Anesthesiology and Surgical Oncology Research Group, Houston, TX
| | - Wendell Williams
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX; Anesthesiology and Surgical Oncology Research Group, Houston, TX
| | - Gabriel E Mena
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX; Anesthesiology and Surgical Oncology Research Group, Houston, TX
| |
Collapse
|
12
|
Porkhanov VA, Zhikharev VA, Polyakov IS, Danilov VV, Kononenko VB. [Video-assisted thoracoscopic thymectomy in myasthenia gravis. New approach]. Khirurgiia (Mosk) 2018:15-21. [PMID: 29652317 DOI: 10.17116/hirurgia20183215-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM To present possibility and technical aspects of anesthetic management during video-assisted thoracoscopic thymectomy in patients with myasthenia gravis. MATERIAL AND METHODS The article describes the proposed modified anesthetic method that is suitable for video-assisted thoracoscopic thymectomy in patients with myasthenia gravis. Nine patients with myasthenia underwent VATS-thymectomy. Anesthesia was performed with artificial airway and auxiliary ventilation without muscle relaxants administration.
Collapse
Affiliation(s)
- V A Porkhanov
- Research Institute - Ochapovsky Regional Clinical Hospital #1, Krasnodar, Russia
| | - V A Zhikharev
- Research Institute - Ochapovsky Regional Clinical Hospital #1, Krasnodar, Russia
| | - I S Polyakov
- Research Institute - Ochapovsky Regional Clinical Hospital #1, Krasnodar, Russia
| | - V V Danilov
- Research Institute - Ochapovsky Regional Clinical Hospital #1, Krasnodar, Russia
| | - V B Kononenko
- Research Institute - Ochapovsky Regional Clinical Hospital #1, Krasnodar, Russia
| |
Collapse
|
13
|
Tamburrini A, Tacconi F, Barlattani A, C. Mineo T. An update on myasthenia gravis, challenging disease for the dental profession. J Oral Sci 2015; 57:161-8. [DOI: 10.2334/josnusd.57.161] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Alessandro Tamburrini
- Thoracic Surgery Division, Multidisciplinary Myasthenia Gravis Unit, Tor Vergata University
| | - Federico Tacconi
- Thoracic Surgery Division, Multidisciplinary Myasthenia Gravis Unit, Tor Vergata University
| | | | - Tommaso C. Mineo
- Thoracic Surgery Division, Multidisciplinary Myasthenia Gravis Unit, Tor Vergata University
| |
Collapse
|
14
|
BLICHFELDT-LAURIDSEN L, HANSEN BD. Anesthesia and myasthenia gravis. Acta Anaesthesiol Scand 2012; 56:17-22. [PMID: 22091897 DOI: 10.1111/j.1399-6576.2011.02558.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2011] [Indexed: 11/30/2022]
Abstract
Myasthenia gravis (MG) is a disease affecting the nicotinic acetylcholine receptor of the post-synaptic membrane of the neuromuscular junction, causing muscle fatigue and weakness. The myasthenic patient can be a challenge to anesthesiologists, and the post-surgical risk of respiratory failure has always been a matter of concern. The incidence and prevalence of MG have been increasing for decades and the disease is underdiagnosed. This makes it important for the anesthesiologist to be aware of possible signs of the disease and to be properly updated on the optimal perioperative anesthesiological management of the myasthenic patient. The review is based on electronic searches on PubMed and a review of the references of the articles. The following keywords were used: myasthenia gravis AND neuromuscular blocking agents, myasthenia gravis AND sevoflurane, myasthenia gravis AND epidural, myasthenia gravis AND neuromuscular blockade reversal and myasthenia gravis AND pyridostigmine. The articles included were from reviews and clinical trials written in English. MG patients can easily be anesthetized without need for post-surgery mechanical ventilation whether it is general anesthesia or peripheral nerve block. Volatile anesthesia or the use of an epidural for the patient makes it possible to avoid the use of neuromuscular blocking agents, and when used, it should be in smaller doses and the patient should be carefully monitored. This review shows that with thorough pre-operative evaluation, continuing the daily pyridostigmine and careful monitoring the MG patient can be managed safely.
Collapse
Affiliation(s)
| | - B. D. HANSEN
- Department of Anesthesiology; Sydvestjysk Sygehus Esbjerg; Esbjerg; Denmark
| |
Collapse
|
15
|
Prolonged Dyspnea after Interscalene Block: Attributed to Undiagnosed Addison's Disease and Myasthenia Gravis. Case Rep Med 2011; 2011:968181. [PMID: 21687552 PMCID: PMC3114601 DOI: 10.1155/2011/968181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 04/13/2011] [Indexed: 11/17/2022] Open
Abstract
This report describes a patient who had a series of daily interscalene nerve blocks to treat pain following a shoulder manipulation for postsurgical stiffness. She experienced acute respiratory compromise that persisted for many weeks. All typical and unusual causes of these symptoms were ruled out. Her treating pulmonologist theorized that the ipsilateral carotid body had been injured. However, it was subsequently determined that the constellation of symptoms and their prolonged duration were best explained by a poor stress response from Addison's disease coupled with exacerbation of early onset myasthenia gravis. This patient's case is not a typical reaction to interscalene nerve blocks, and thus preoperative testing would not be recommended for myasthenia gravis or Addison's disease without underlying suspicion. We describe this report to inform physicians to consider a workup for these diagnoses if a typical workup rules out all usual causes of complications from an interscalene block.
Collapse
|