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Abstract: The patient, a 41-year-old female, recently presented with unclear vision and inability to lift her eyelids, which had not been a concern, and then her condition worsened and she came to the hospital for examination, after which she was diagnosed with myasthenia gravis. The patient was advised to be hospitalized to give medication and underwent thymoma surgery at a higher level hospital. The patient had no other special discomfort after surgery and no significant drooping of the eyelids bilaterally.
[Basic information] Female, 41 years old
Disease Type】Myasthenia gravis
Hospital】Shandong Provincial Third Hospital
Date of Consultation】May, 2020
Treatment plan】Medication (bromipyridamole tablets, dexamethasone sodium phosphate injection, ginkgo biloba extract injection) + thymoma surgery
【Treatment period】7 days of hospitalization, 1 month of outpatient follow-up
Treatment effect】No other special discomfort after surgery, no significant drooping of bilateral eyelids
I. Initial consultation
The patient, a 41-year-old female, recently found that she could not lift her eyelids and could not see clearly, but she did not care about it until she came to the hospital because her symptoms worsened and affected her farm work. Neurological examination was performed and revealed bilateral eyelid ptosis and positive eyestrain test, the rest of the examination did not show any obvious positive signs, so the possibility of myasthenia gravis was considered. The patient and family expressed understanding and actively cooperated with the treatment.
II. Treatment history
After the patient was admitted to the hospital, the relevant examinations were completed, and the laboratory tests of blood routine, liver and kidney function, ion, lipid, blood glucose, cardiac enzyme and glycated hemoglobin did not show any significant abnormality. The patient had positive neostigmine test, positive ocular electromyogram suggesting heavy frequency stimulation, and chest CT suggesting thymoma. Since there is a certain correlation between thymoma and myasthenia gravis, the diagnosis of myasthenia gravis was considered clear in combination with the patient’s current symptoms. After admission, the patient was given oral bromipyridamole tablets, dexamethasone sodium phosphate injection and ginkgo biloba extract injection. The condition improved after 7 days of hospitalization after treatment, and the symptoms of bilateral ptosis were reduced compared to before. Surgery for thymoma was recommended, but the patient requested to go to a higher level hospital for surgery, so he was discharged and has completed thymoma surgery after 1 month of follow-up by phone, and his condition is now stable.
III. Treatment effect
Myasthenia gravis is an autoimmune disease with lesions in the neuromuscular junction, and it is more likely to be related to heredity and immune deficiency. The patient’s bilateral eyelid ptosis was relieved on the third day of treatment after admission, and the bilateral eyelids could be completely lifted on the seventh day. Considering that the patient’s current symptoms were mild and well treated, he belonged to the simple oculomotor type of myasthenia gravis, and it was recommended to perfect thymoma surgery at an elective stage. However, the patient requested to undergo surgery at a higher level hospital and has completed the surgical treatment at the telephone follow-up after 1 month, with no other special postoperative discomfort, no significant bilateral eyelid ptosis, and a better treatment effect.
IV. Notes
We are glad that the patient recovered from the treatment of bilateral ptosis. However, myasthenia gravis can involve the skeletal muscles of the whole body or some of them, and in severe cases, it can manifest as generalized skeletal muscle weakness and even affect the respiratory muscles leading to respiratory failure, which is life-threatening. Therefore, patients should pay attention to the improvement of myasthenia gravis and the presence of symptoms such as dyspnea and breath-holding during medication. If there is dyspnea and breathlessness, it does not exclude the aggravation of myasthenia gravis, which involves the skeletal muscles of the whole body, and requires immediate hospital treatment. Patients should develop good living habits, avoid emotional excitement, avoid straining, supplement nutrition, exercise, improve immunity and promote the recovery of the organism during weekdays.
V. Personal insight
In this case, the patient’s condition was delayed again and again because of the fear of spending money, but fortunately the condition was not serious, and after treatment, a better treatment effect was obtained. Therefore, you should pay more attention to your health condition and go to the hospital for regular checkups. Medical workers should also pay high attention to such patients, urging them to follow up regularly at the hospital and explaining the seriousness of their condition, so that they do not come to the hospital for fear of spending money, resulting in aggravation of their condition without knowing it.