Question

A 32 year old African American male is brought to the Emergency Department by his wife who states he has been “walking funny”. The patient states he is having weakness in his legs which has recently started progressing to his upper extremities. He has been fatigued this week. Since waking up today, he has been experiencing double vision with a left sided visual field spot. While examining the patient, he mentions that the weakness of the legs has occurred in the past but he did not think much of it. He also reported an episode of double vision 3 months prior but the double vision resolved after he rubbed his eyes and blinked a few time.

1. As the Emergency room physician, what are your top 3 differential diagnoses?
2. What questions might you ask your patient to narrow these down to one working diagnosis?
3. What is the pathogenesis of this diagnosis?
4. What treatments, if any, are available?
5. What is the most current literature relating to drugs used to treat this disease?
6. How would you educate your patient regarding prognosis and plan of care moving forward?

Answer 1

New tuminal Synaptic U veride k Acetyl choline og receptor -ruscle fiber 1 Medications - corticosteroide :- It inhibit the immune system limit the antibody production Cholinesterase inhibitors: - Medication as pyidostigmine and neostigmine enhance communication between neeves and muscles. 2) 3) Immunosuppeasants

Top 3 diferential diagnouis 1) Myasthenia chavis 2) Chave's diseases 3) multiple sclerosis 6) Questions to patients: - . ) Is patient suffering (complaining any other muscle weakness as difficulty in swallowing / chewing / speakinge 2) Is patient complaining weakness in his neck and arms also q yes then patient is suffering from Myasthenia craws. It is characterised by weaknew and falgue of muscles under voluntary control (skeletal muscle). - As patient is complaining double vision which means eye muide is not working properly - As patient is complaining walking funny, which mean leg muscles are not working properly c) Pathogenesis of the diagnosis :- myasthenia wavis (MG) is an autoimmune disease of the neuromuscular junction. In this disease body produced antibodies against the acetylcholine receptor. Neuromuscular junction is site where neve cells an muscle cells interact