Neurocritical Care
Respiratory failure
Autonomic dysfunction resulting in arrhythmia, hypertension, hypotension
Neuropathic pain
Intravenous immunoglobulin versus plasma exchange
Therapies are essentially equivalent.
Plasma exchange: Five treatments over 2 weeks
Intravenous immunoglobulin: 0.4 g/kg intravenously daily Γ 5 days
| d. | Combination of therapies no better than single therapy alone |
|---|
Benefit of repeated treatments is unclear.
Steroids are not particularly effective.
Supportive Care
VTE prophylaxis is imperative.
Dysphagia is common, so enteral feeding access is necessary in most cases.
Neuropathic pain is common; use opiates with caution to avoid respiratory depression.
Euvolemia to minimize autonomic instability
Annual incidence of myasthenia gravis is 1 or 2 per 100,000.
illness.
Patients with myasthenia crisis typically present with respiratory failure caused by muscle weakness.
Myasthenia crisis is usually preceded by a predisposing factor.
Respiratory infection
Emotional stress
Aspiration
| d. | Changes in myasthenia gravis medication regimen |
|---|
Addition of medications that may oppose acetylcholine effects at the neuromuscular junction and
exacerbate myasthenia gravis symptoms (Box 3)
Other physiologic stress (trauma, surgery)
Box 3. Pharmacologic Agents Associated with Myasthenia Crisis
Aminoglycosides
Ξ²-Blockers
Fluoroquinolones
Macrolides
Magnesium
Neuromuscular blockers
Procainamide
Quinidine
Tetracyclines
Verapamil