MYASTHENIA – DIFFICULTIES IN DIAGNOSTICS AND TREATMENT (CLINICAL CASE ANALYSIS)
Myasthenia gravis is an autoimmune rapidly progressive disease characterized by a neuromuscular disorder due to the formation of autoantibodies to different epitopes of the peripheral neuromuscular device and is clinically manifested by pathological muscle fatigue and weakness. Diagnosis of myasthenia in the elderly is very problematic because doctors regard muscle weakness at this age as a symptom of other diseases. In addition, it may be combined with various pathological conditions. The article describes the presence of comorbid states in patients with myasthenia who were treated at the neurological department of Lviv regional clinical hospital in 2016-2018. 58% of patients with myasthenia, mainly older people, had comorbid diseases. Hypertensive heart disease (34%), ischemic heart disease (20%), diabetes mellitus (12%,) and small brain vessels disease (8%) were frequently observed. A case of late diagnosed generalized myasthenia in a 66-year-old woman with concomitant small vessels disease of the brain and diabetes mellitus is described. The patient was treated at the neurological department of Lviv regional clinical hospital in December 2018. For a long time, the patient had been treated of the small vessels disease, though main complaints were difficulties with speaking, swallowing, periodic double vision, ptosis, general weakness, weakness in the right leg, memory impairment, problems with walking and urination. The diagnosis of myasthenia was based on clinical manifestations, a positive reaction to acetylcholinesterase inhibitors, and detection of antibodies to acetylcholine receptors. Clinical manifestations of myasthenia, as well as apraxia of walking, disorders of urination and cognitive impairment due to vascular changes in the brain intensified the patient's disability and created the need for careful outside care and control of the drug intake. The positive influence of anticholinesterase drugs and prednisolone in the treatment of myasthenia was noted. The presence of diabetes mellitus is a relative contraindication to the administration of corticosteroids, but in the presence of comorbidity of generalized myasthenia and diabetes mellitus type II, prednisolone was used under constant monitoring of blood glucose by hypoglycemic agents. Thus, late-onset, severe comorbid diseases (small vessel disease of the brain, diabetes mellitus) complicate and delay the diagnosis of myasthenia and prescription of appropriate therapy.
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