RT Book, Section
A1 Frontera, Jennifer
A1 Ferreira da Silva, Ivan Rocha
A2 Lee, Kiwon
SR Print(0)
ID 1143954372
T1 Neuromuscular Diseases
T2 The NeuroICU Book, 2e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9780071841443
LK neurology.mhmedical.com/content.aspx?aid=1143954372
RD 2024/04/23
AB A  26-year-old  woman  with  no  past  medical  history  presents  to  the  emergency  department  with  several  days  of  fatigue,  difficulty  climbing  stairs,  and  double  vision.  She  has  one-word  dyspnea  and  appears  to  be  retracting.  Her  chest  x-ray  is  normal,  as  are  all  her  initial  laboratory  studies.  She  mentions  having  had  an  upper  respiratory  infection  1  week  before.  She  does  not  take  any  medications  and  has  not  traveled  recently.  Vital  signs:  heart  rate,  105  bpm;  sinus  tachycardia;  blood  pressure,  145/90  mm  Hg;  respiration  rate,  30  breaths  per  minute;  temperature,  37.2°C.  She  is  in  moderate  respiratory  distress  and  is  using  accessory  muscles  of  respiration.  She  has  no  rashes.  She  is  drooling  and  has  difficulty  clearing  her  secretions.  Her  oropharynx  is  clear.  Her  neurological  examination  is  notable  for  ptosis,  bilateral  6th  nerve  palsy,  bilateral  facial  weakness,  and  neck  flexion,  3/5;  deltoids,  3/5;  biceps,  3/5;  triceps,  3/5;  wrist  extensors  and  intrinsic  hand  muscles,  5/5;  ileopsoas,  4+/5;  quadriceps,  4+/5;  hamstrings,  5/5;  tibialis  anterior,  5/5;  and  gastrocnemius,  5/5.  Her  sensory  examination  is  normal,  as  are  her  reflexes.