Misdiagnosis of myasthenia gravis and subsequent clinical implication: a case report and review of literature

The autoimmune disease, myasthenia gravis [MG], can mimic a variety of neurological disorders leading to a delay in diagnosis and treatment. On occasions, misdiagnosis of MG could lead to unnecessary and potentially harmful therapeutic interventions. We report on a 12 year-old boy, in whom MG was mistaken for meningitic sequelae and subsequently for critical neuropathy/myopathy resulting in considerable morbidity for nearly a decade. Subsequent correct diagnosis and optimal management resulted in significant improvement in his functional status. We discuss the importance of considering MG as one of the potential differential diagnoses among cases of recurrent respiratory pump failure, or unexplained bulbar symptoms where documentary proof of the previous diagnoses including work-up for MG is lacking. We also review the literature on MG misdiagnosis and highlight the potential pitfalls in MG diagnosis

Spinal cord infarction following abdominal surgery and postoperative epidural analgaesia

Ischemic infarction is a rare cause of acute myelopathy. We report the case of a young woman admitted to Sultan Qaboos University Hospital, Oman, who developed extensive spinal cord infarction in the setting of surgical evacuation and packing of liver haematoma and post-operative epidural analgesia. She had no vascular risk factors for stroke. The vascular mechanism underlying ischemic myelopathy and the relationship to abdominal surgery and epidural analgesia are discussed