Myasthenia gravis with superimposed spinal cord injury: a case report.

Both myasthenia gravis and traumatic spinal cord injury are uncommon disorders and their concurrence is extremely rare. We report here the case of a man with stable myasthenia gravis with spinal cord injury due to a motor vehicle accident. His muscle strength and sensory function in all 4 limbs partially recovered during the initial hospitalization. However, after a later episode of pneumonia and urinary tract infection, muscle strength deteriorated and weakness of the ocular muscles occurred. A relapse of myasthenia gravis was confirmed by the elevated anti-acetylcholine receptor antibody titre. Muscle strength recovered rapidly after control of infection and treatment of myasthenia gravis exacerbation. In this case report, we show that spinal cord injury-related complications, including infection or emotional stress, could
trigger a relapse of myasthenia gravis. This highlights the importance of recognizing an exacerbation of myasthenia gravis in spinal cord injury patients with a history of myasthenia gravis, since they are prone to urinary and pulmonary infection. Although exacerbation of myasthenia gravis might prolong hospitalization, the functional outcome of spinal cord injury might not be affected if the exacerbation is diagnosed and treated quickly.

Mayo Clinic Guide to Living with a Spinal Cord Injury

STUDY DESIGN:
Case report.
BACKGROUND/OBJECTIVE:
Myasthenia gravis (MG) complicating spinal cord injury (SCI) is extremely rare. We report a patient with SCI developing MG leading to death. There are no similar articles at present on literature search.
CASE REPORT:

A 54-year-old man, paralysed at the T12 level (ASIA A) for 40 years, was admitted for surgical repair of his grade IV sacral pressure sore. During the admission he developed diplopia, fluctuating dysphagia and slurred speech. Elevated anti-acetylcholine receptor antibodies and single fibre electromyography confirmed the diagnosis of MG and pyridostigmine was commenced. His admission was complicated by intermittent episodes of unexplained tachycardia and tachypnoea. He succumbed following cardiorespiratory within 6 weeks of admission. Post mortem examination was inconclusive of a definite cause of death. In the presence of SCI, it can be challenging to diagnose MG or its complications like myasthenic and cholinergic crisis.

CONCLUSION:
The case highlights the difficulty in diagnosis and management of MG in persons with SCI

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J Rehabil Med. 2008 Aug;40(8):684-6. doi: 10.2340/16501977-0222.
Source
Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.

Superimposed myasthenia gravis in chronic spinal cord injury: a case report.
Kolli S, Mathew KM, Thumbikat P, McClelland MR, Nair KP.
Source
Princess Royal Spinal Injuries Unit, Northern General Hospital, Sheffield, UK. drkollisridhar2@hotmail.com
Abstract