Lady With the Blue Hair: An Atypical Cause of Myasthenic Crisis.

A myasthenic crisis denotes a severe exacerbation of myasthenia gravis, leading a patient to enter a life-threatening state due to progressing muscle weakness that ultimately results in respiratory failure. A crisis can require intubation, mechanical ventilation, and additional critical care to prevent further decompensation and potentially death. Numerous well-documented precipitating factors exist, such as infections, surgery, stress, and various medications. We present the case of a 43-year-old woman recently diagnosed with myasthenia gravis who has experienced two myasthenic crises since diagnosis without evident triggers such as surgery, changes in medication, or infection. Following an unremarkable initial diagnostic test and continued treatment for the crisis, we sought additional information from the patient's family member at the bedside. We were informed that two weeks prior to both times of crisis with intubation, the patient had dyed her hair blue. The common chemical component in the two different hair dyes used was methylisothiazolinone, which is suspected to have contributed to the exacerbation of the patient's myasthenia gravis. As more evidence for new precipitating factors of myasthenic crises develops, it is crucial for physicians to quickly identify signs and symptoms of a crisis so appropriate intervention can occur in a time-sensitive manner. In addition, myasthenia gravis patients should be made aware to be cautious of precipitating factors of a crisis, including but not limited to new beauty products.

Incidental Finding of an Exceptionally Large Left Atrial Myxoma Presenting as an Acute Cardioembolic Stroke.

Left atrial myxomas are rare tumors that arise in the left atrium of the heart. As they become larger, they tend to grow into the atrial lumen and disrupt cardiac hemodynamics. Commonly reported symptoms include dyspnea, orthopnea, cough, peripheral edema, and fatigue. On physical examination, a characteristic "tumor plop" may be heard in some patients early in diastole. Left atrial myxomas may cause emboli to be released into the systemic circulation, which can lead to acute cardiovascular events, including strokes. We present the case of a 43-year-old female with sudden-onset slurred speech, left facial droop, and left-sided hemiplegia. CT angiography of the brain revealed a right middle cerebral artery infarct, and the patient underwent emergent mechanical thrombectomy. Upon workup for secondary causes of stroke, echocardiogram revealed an incidental 8 cm left atrial myxoma. After stabilization in the ICU, the patient was taken to surgery and the tumor was successfully removed. Over the course of admission, the patient's left-sided hemiplegia gradually improved, and she was eventually transferred to inpatient rehabilitation care. A multidisciplinary effort involving medicine teams, neurology, cardiology, cardiothoracic surgery, neuro-interventional radiology, pain management, and endocrinology was essential in reaching the diagnosis. This case highlights the importance of considering a primary cardiac tumor such as a left atrial myxoma in the differential diagnosis when evaluating for secondary causes of acute ischemic stroke.