Fast Five Quiz: Myasthenia Gravis Emergency Management

Richard Nowak, MD, MS

Disclosures

July 07, 2021

Bulbar symptoms in general are indicative of a severe disease exacerbation. The voice may take on a nasal quality during an exacerbation. Slackened facial muscles, slackened jaw, inability to support the head, weakness throughout the body, absence of gag reflex, and respiratory signs/symptoms may also point to a severe MG exacerbation.

MG is a disorder affecting nicotinic cholinergic receptors, so dysautonomia does not occur.

During an exacerbation, oropharyngeal secretions accumulate because the patient cannot cough; therefore, rales, rhonchi, and wheezes may be auscultated locally or diffusely due to aspiration. The patient may also show signs of pneumonia (ie, fever, cough, dyspnea, consolidation).

Because breathing can become rapid and shallow, patients who have a severe exacerbation may seem anxious. Chest movements may become paradoxical due to diaphragmatic weakness. 

MG is marked by painless muscle fatigue. Despite weakness, reflexes remain normal.

Myasthenic crisis can be differentiated from other neuromuscular conditions by absence of fasciculations or automatic symptoms, as well as by the presence of normal reflexes, normal sensation, and worsening weakness with repetitive motion.

Learn more about the physical examination of patients with MG.

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