Case of the Month #18 - myasthenic crisis

Published 01/02/2022

What are the red flags for an impending myasthenic crisis?

  • Febrile infection in the last 2 weeks treated with antibiotics
  • ‘Inverse aspiration’ – food and drink entering the nose after swallowing
  • Insufficient swallowing: coughing or clearing the throat after swallowing
  • Aphonic dysarthria: weakness of phonation during speech with a nasal pronunciation
  • ‘Dropped head’ – head falls forwards because of weakness of neck extensor muscles
  • ‘Dropped chin’ – lower jaw drops after chewing
  • New facial weakness
  • Vital capacity <20ml/kg body weight (<1500ml in men, <1000ml in women)