MYASTHENIA GRAVIS PRESENTS AS BULBAR PALSY WITHOUT THYMOMA

Аннотация

INTRODUCTION antibodies and the severity of MG, suggesting that When the body's immune system mistakenly individuals who test positive for these antibodies targets its own postsynaptic acetylcholine may have a more difficult clinical experience, as receptors (AChR) and leads to fatigue that occurred in a patient who was wrongly diagnosed improves with rest goes by the name of myasthenia with motor neuron disease (MND), demonstrating gravis (MG) [1]. Thymoma and thymic hyperplasia the challenges of identifying bulbar palsy. The are associated with MG [2]. The clinical patient's experience, marked by worsening bulbar classification system established by the symptoms and puzzling upper motor neuron signs, Myasthenia Gravis Foundation of America (MGFA) emphasizes the importance of conducting divides MG into 5 primary classes, depending on thorough clinical assessments, especially in older the severity and specific clinical features. Although individuals [4-6]. the most common form of MG is ocular (50%), manifested with ptosis, class IIb is characterized by Our case report details the clinical progression of a predominant involvement of the oropharyngeal MG and the importance of emphasizing the and respiratory muscles [3]. There is a strong significance of timely and accurate diagnosis. connection between the existence of AChR https://www.theamericanjournals.com/index.php/tajmspr 13 THE USA JOURNALS THE AMERICAN JOURNAL OF MEDICAL SCIENCES AND PHARMACEUTICAL RESEARCH (ISSN – 2689-1026) VOLUME 06 ISSUE08 Case presentation: nystagmus or diplopia, normal convergence and accommodation, and sufficient photoreactions. Case 1 Prominently, the patient exhibited dysphagia and A 56-year-old male presented with difficulty dysphonia. The absence of tremor with no change swallowing and feeling of a lump in the throat, in muscle tone was considered. Deep tendon choking, hoarseness, dyspnea, and dizziness, which reflexes (Biceps, Radial brachialis, Triceps, Distal persisted for a month. Initially, the patient had finger flexors, Quadriceps knee jerk, Ankle jerk) are hoarseness and nasal voice; the general intact with the negative plantar reflex (Babinski practitioner (GP) treated it as a common cold. sign). Sensory loss and meningeal signs are not Following 10 days, his condition got worse, and detected. Romberg test and further coordination new symptoms such as choking, inability to tests were performed confidently. He was referred swallow, and shortness of breath started to appear. to undergo a comprehensive analysis consisting of GP referred this patient to the neurologist, where blood tests, electroneuromyography (ENMG), he was diagnosed with motor neuron disease nerve conduction test (NCT), and chest Computed (MND) in Surkhandarya, a region of Uzbekistan. Tomography (CT). The treatment plan with 15mg of corticosteroids Prior to the patient’s arrival at our hospital for the showed no improvement. Due to the deficiency of comprehensive assessment, he was unable to nutrients, he experienced a general weakness, undergo a blood test for antibody detection which eventually led him to AKFA Medline because it was not accessible in his previous University Hospital. healthcare setting. Upon arrival, he underwent He has no allergy history. Type 2 Diabetes Mellitus, serological testing, where blood test results managed with insulin twice daily, was notable in showed normal anti-skeletal muscle antibodies his medical history. The patient’s general condition (IgG), elevated (0.78 units/ml) muscle-specific during the examination was satisfactory, with clear tyrosine kinase antibody (MuSK, IgG), and consciousness and orientation in time and place. significantly elevated level (2.34 nmol/l) of Neurological examination revealed regular and acetylcholine receptor antibody (Table 1). round pupils with full eyeball movement, no Test Result Norma Units s Striated Muscle Antibody, 16 up to 20 IgG Muscle-specific tyrosine 0.78 up to 0.40 U/mL kinase antibody (MuSK), IgG https://www.theamericanjournals.com/index.php/tajmspr 14 THE USA JOURNALS THE AMERICAN JOURNAL OF MEDICAL SCIENCES AND PHARMACEUTICAL RESEARCH (ISSN – 2689-1026) VOLUME 06 ISSUE08 Acetylcholine Receptor 2.34 less than 0.45 nmol/L (ACHR) Antibody Table 1. Antibody testing results in Case 1. come to a more accurate treatment strategy. ENMG demonstrated a weakly positive decrement test following pyridostigmine administration, with In a clinical evaluation, a chest CT scan (Figure 1) normal muscle unit (MU) action potentials and no was performed as part of the standard diagnostic spontaneous activity in needle EMG of the deltoid procedure for a patient with MG to check for and general extensor muscles of the hand. Post- thymoma. The absence of any abnormalities in the administration of 2 ml of neostigmine showed no thymus allows us to focus more on addressing the clinical changes and a negative decrement in autoimmune aspect of MG without having to ENMG. No signs of motor neuronal pr