Post-malaria myasthenia gravis

We report a nine-year-old girl who presented with complete drooping of the left eyelid and restriction of medial gaze following an attack of febrile illness. The child was admitted into a rural hospital where she was misdiagnosed and managed as a case of meningitis. She was referred to a tertiary children hospital when her condition was not improving and where she developed the eye signs. She was diagnosed as a case of severe malaria which responded well to quinine therapy. In our neurophysiology clinic, examination revealed partial unilateral left eye ptosis, weak frontalis, neck flexors, fingers extensors & knee flexors. Her investigations revealed positive neostigmine test, decremental response to repetitive nerve stimulation(-15.6%,nasalis), increased jitter in single-fibre electromyography (left frontalis & extensor-digitorum communis) and negative serology for myasthenia gravis antibodies. She showed remarkable improvement after pyridostigmine therapy which continued for three months. Regular follow-up showed no recurrence of her symptoms

The Pattern and Presentation of Myathenia Gravis in Al-Shaab and Omdurman Teaching Hospitals

Introduction:Myasthenia gravis (MG) is the most common acquired autoimmune disorder of neuromuscular transmission. It has different patterns of presentation. Objective: to study the pattern and mode of presentation of Myasthenia Gravis in Al-Shaab and Omdurman Teaching Hospitals; Khartoum Sudan. Methods: The demographic and clinical characteristics of 50 patients of myasthenia gravis (MG) were reviewed in Alshab and Omumdrman Teaching Hospitals for five months period from May to October 2008.Results: Out of 2400 patients attending neurology clinics 50 were found to have Myathenia Gravis [MG] with female; male ratio of 2.5:1. The age at presentation was the second decade of life in 34. Most of the patients [42] were from Khartoum State followed by North Kordofan State [14]. High occurrence of late onset fatigability and weakness was seen in 92of our patients. Ocular muscles involvement was detected in 78. MG was aggravated by hot weather and fever in 12of the patients. Quinine represented the most common drug which aggravated the myasthenia symptoms in 4. Diabetes mellitus and thyroid diseases were the most associated auto immune diseases seen in 12and 4respectively. The diagnosis was made by classic history and neurological examinations in 88and positive neostigmin test in64. The majority of patients were treated with steroids. Thymectomy was done in 10patients. The outcome was excellent as 82improved and only one [2] patient died.Discussion: Going with literature diagnosis of MG was made depending on classical history; full neurological examination and confirmed by tensilon test. Because of different reasons more sophisticated tests were not done in our patients. Only patients with malaria who were treated with quinine showed deterioration of their symptoms in our study. Strikingly; myasthenia crisis which were reported in 27of patients were not seen in our population. Because of lack of usage of steroid sparing agents the vast majority [96] of our patients were treated with steroids. Conclusion:Generalized myasthenia gravis with ocular involvement is common in our patients. However; pure OMG was not seen. Thymectomy was done in a small number of our patients with reference to other studies

Le traitement de la forme ophtalmologique des myasthenies par une haute dose de prednison

L'incidence de l'ophtalmoplegie externe au cours des myasthenies est tres elevee. 75 pour cent des patients font leurs premieres consultations en ophtalmologie; a cause de l'atteinte des muscles occulaires comme premiers signes cliniques. En l'intervalle de deux ans 80 pour cent de ces malades developpent la forme generale des myasthenies. Il est prouve que c'est une maladie auto-immune. A partir du 5 mai 1995; 10 cas developpent la forme ophtalmique ont ete recencees au cours des consultations. Les autres ont recu une haute dose de prednison. Le present article presente le rapport d'un resultat satisfaisant

Myasthenia gravis in a child. [case report]

A ten year old girl presented with a three month history of diminished vision and tiredness towards the end of the day. There were no other complaints. On examination; the patient had ptosis of the left eye which improved after a period of sleep. She was also myopic. Clinical examination was otherwise normal. There were no evidence of weakness of any ather muscles. The diagnosis with the tensilon test and the sleep test had shown that the patient had a myasthenia gravis