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Li W, He L, Jin X, Li L, Sun C, Wang C. Isolated dysarthria as the sole manifestation of myasthenia gravis: a case report. J Int Med Res 2022; 50:3000605221109395. [PMID: 35915860 PMCID: PMC9350514 DOI: 10.1177/03000605221109395] [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] [Indexed: 11/16/2022] Open
Abstract
Myasthenia gravis (MG) is an acquired autoimmune disease. Its clinical
manifestations comprise ptosis, diplopia, dysarthria, dysphagia, limb weakness,
and in severe cases, respiratory muscle involvement. Dysarthria as an exclusive
initial and primary complaint in MG is rare and seldom reported. In this paper,
we report a case of type IIIb MG with isolated dysarthria as the only clinical
manifestation and we review the relevant literature. The patient was a
62-year-old man who presented with episodes of slurred speech for 20 days that
had worsened in the previous 9 days. His medical history comprised hypertension,
diabetes mellitus, and coronary heart disease. The initial diagnosis on
admission was transient ischemic attack. Careful re-examination of the patient’s
history revealed that his symptoms mainly involved increasingly worse slurred
speech episodes without drinking or swallowing difficulties, and no significant
improvement with rest was observed. Electromyography and autoantibody profiling
led to a diagnosis of type IIIb MG. His symptoms improved after the oral
administration of pyridostigmine bromide 60 mg. Laryngeal MG is important to
differentiate from stroke. It is necessary to perform a computerized voice
analysis when encountering patients with atypical symptoms of MG.
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Affiliation(s)
- Wei Li
- Department of Geriatrics, ZiBo Central Hospital, Zibo, China
| | - Ling He
- Department of Neurology, Jilin Central General Hospital, Jilin, China
| | - Xiaodong Jin
- Department of Geriatrics, ZiBo Central Hospital, Zibo, China
| | - Li Li
- Department of Geriatrics, ZiBo Central Hospital, Zibo, China
| | - Congcong Sun
- Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Cuilan Wang
- Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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Frisullo G, Scala I, Bellavia S, Broccolini A, Brunetti V, Morosetti R, Della Marca G, Calabresi P. COVID-19 and stroke: from the cases to the causes. Rev Neurosci 2021; 32:659-669. [PMID: 33583167 DOI: 10.1515/revneuro-2020-0136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/19/2021] [Indexed: 12/24/2022]
Abstract
During COVID-19 pandemic, a wide variety of stroke typologies have been described in patients affected by SARS-CoV-2. Investigating the case reports of acute stroke in COVID-19 patients, published since the beginning of the pandemic, we tried to trace the pathogenic mechanisms of stroke during SARS-CoV-2 infection. We conducted a systematic review analyzing demographic data, cerebrovascular risk factors, NIHSS score, vascular territory involvement and laboratory findings of 168 patients described in 89 studies, from a pool of 1243 records. Based on our results, we have identified different stroke profiles: (1) cerebral large vessel disease (CLVD) profile with a low disability, simultaneous onset of COVID-19 and stroke symptoms, good outcome and low serum levels of D-dimer and CRP; (2) intracranial bleeding (IB) profile with high disability, poor outcome and low levels of serum markers of inflammation and coagulopathy; (3) CLVD profile with a short time-lapse between COVID-19 symptoms and stroke onset, high neurological disability and very high systemic inflammatory markers; (4) multiple thrombo-embolic disease (MTED) profile with older patients, many comorbidities, disabling stroke, poor outcome, evident alteration of coagulation tests and high serum levels of both D-dimer and CRP. We therefore summarized these different profiles in a spectrum similar to that of visible light, where the violet-blue band included IB and CSVD with low inflammation and prothrombotic activity, the green-yellow band included CLVD with high inflammation and moderate prothrombotic activity and the orange-red band for MTED with moderate-high levels of inflammation and very high prothrombotic activity.
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Affiliation(s)
- Giovanni Frisullo
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Neurologia, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Largo A Gemelli, 8, 00168, Rome, Italy
| | - Irene Scala
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Neurologia, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Largo A Gemelli, 8, 00168, Rome, Italy.,Catholic University of Sacred Heart, Rome, Italy
| | - Simone Bellavia
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Neurologia, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Largo A Gemelli, 8, 00168, Rome, Italy.,Catholic University of Sacred Heart, Rome, Italy
| | - Aldobrando Broccolini
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Neurologia, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Largo A Gemelli, 8, 00168, Rome, Italy.,Catholic University of Sacred Heart, Rome, Italy
| | - Valerio Brunetti
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Neurologia, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Largo A Gemelli, 8, 00168, Rome, Italy
| | - Roberta Morosetti
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Neurologia, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Largo A Gemelli, 8, 00168, Rome, Italy
| | - Giacomo Della Marca
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Neurologia, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Largo A Gemelli, 8, 00168, Rome, Italy.,Catholic University of Sacred Heart, Rome, Italy
| | - Paolo Calabresi
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Neurologia, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Largo A Gemelli, 8, 00168, Rome, Italy.,Catholic University of Sacred Heart, Rome, Italy
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