TY - CHAP M1 - Book, Section TI - Neuromuscular Diseases A1 - Frontera, Jennifer A2 - Lee, Kiwon PY - 2012 T2 - The NeuroICU Book AB - A 26-year-old woman with no past medical history presents to the emergency department (ED) with several days of fatigue, difficulty climbing stairs, and double vision. She has one-word dyspnea and appears to be using accessory muscles of respiration. Her chest radiograph is normal as are all her initial laboratory studies. She mentions having an upper respiratory infection 1 week ago. She does not take any medications and does not have any recent travel. Vital signs: HR 105 bpm, sinus tachycardia, BP 145/90 mm Hg, RR 30 breaths/min, temperature 37.2°C. Examination: The patient is in moderate respiratory distress and using accessory muscles of respiration. She has no rashes. She is drooling and has difficulty clearing her secretions. Her oropharynx is clear. Her neurologic examination is notable for ptosis, bilateral sixth nerve palsy, bilateral facial weakness, neck flexion 3/5, deltoids 3/5, biceps 3/5, triceps 3/5, wrist extensors and intrinsic hand muscles 5/5, iliopsoas 4+/5, quadriceps 4+/5, hamstrings 5/5, tibialis anterior 5/5, gastrocnemius 5/5. Her sensory examination is normal as are her reflexes. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/10/09 UR - neurology.mhmedical.com/content.aspx?aid=1101642724 ER -