MIASTHENIA GRAVIS

Patient identity
Name : Mr.E
Age : 30 tahun
Adress : Dharma Bakti street Payung Sekaki
Pekanbaru
Admission : september 9th 2016

Chief Complain
Weak in the extremity

Recent illness history

patients present with complaints of weakness in
the extremity and difficulty breathing since a few
hours
before
admission.
Complaints
accompanied eyelids down, the body feels weak
to move the extremity.

3 years before admission to hospital, patient

complained of symptoms beginning left eyelid
down. Patients went to the specialist in internal
medicine and showed no abnormalities and he
went to an eye specialist, he expressed no
interference, then he went to a neurologist and
he was suffering from myasthenia gravis. He
treated at Awal brosss hospital.

Past illness history

Diabetes Melitus (-)
Hypertension (-)
Auto immune (-)

Family illness history

No family illness history(-)

Physical examination
General status
Awareness
: Conssist
General state
: look moderate illness
Blood pressure
: 120/80 mmhg
Heart rate
: 74 times/ minutes
Respiratory rate : 20 times/ minutes
Temperature
: 36,50 C (axilla)

 Head and neck : Localized status

Chest
: Within normal limit
Abdomen
Extremity

: Within normal limit

: Localized status

Head and neck

Ptosis (+/+), pupil isokor (+/+)
Enlarged lymph nodus (-)
Extremity
Motorik 4 3
3 3

Working diagnose
Tetraparese et causa myasthenia gravis

Supporting exam
Electrolyte (06/09/2016)
Na: 136 mmol/L (n)
Ka: 3,6 mmol/L (n)
Cl : 102 mmol/L (n)
Routine blood (06/09/2016)
Hb
: 17,3 g/dl (n)
Leukocytes : 18.0000 / ul (high)
Ht
: 50,3 % (n)
Platelet
: 160.000/ul (n)
Blood sugar : 102 mg/dl (n)

10 sept 2016
Bun : 32 mg/dl
Cr
: 0.60 mg/dl

Foto thorax
No abnormalities

Ct scan thorak dengan kontras

Tampak lesi isodens homogen batas tegas uk 1.95 x 1.4
x 2.67 cm di daerah mediastinum superior anterior.
Perbesaran jantung(-)
Esofagus dbn. Trakhea dbn.
Diafragma dbn.
Infiltrat(-)
Bayangan massa atau nodul di kedua lap.paru(-)
Kesan: massa isodens homogen batas tegas di daerah
mediastinum superior anterior ec. Sugestif thymoma.

Treatment

IVFD RL 18 dpm
Inj methyl prednisolon 2 x 125 mg
Inj Ranitidin 2 x 1 ampul
Mistenol 3x1 tab
ATP 1X1

Myasthenia gravis
A chronic, progressive autoimmune neurologic
disease that affects the postsynaptic portion of
the neuromuscular junction

Classification of MG

Early-onset MG: age at onset < 50 years. Thymic

hyperplasia, usually females
Late-onset MG: age at onset > 50 years. Thymic
atrophy, mainly males
Thymoma-associated MG (10%15%)
MG with anti-MUSK antibodies
Ocular MG (oMG): symptoms only affecting
extraocular muscles
MG with no detectable AChR and muscle-specific
tyrosine kinase (MuSK) antibodies

There are four basic therapies used to treat MG:

Symptomatic treatment with
acetylcholinesterase Inhibitors
Rapid short-term immunomodulating treatment
with plasmapheresis and intravenous
immunoglobulin
Chronic long-term immunomodulating
treatment with glucocorticoids and other
immunosuppressive drugs
Surgical treatment.

 A thymoma is a tumor that arises in the thymic

gland, an organ that resides under the
breastbone on top of the heart and great vessels.
Thymomas can be benign or malignant, meaning
some of them are surrounded by a capsule and
are self-contained, while others invade the
structures in the chest or spread into other areas
of the body.

thymectomy