Miyastenik kriz: 3 olgu sunumu ve literatürün gözden geçirilmesi

Son bir yıl içerisinde miyastenik kriz epizodları geçiren üç olgunun kayıtları gözden geçirildi. Krize eşlik eden diğer nedenler, tedaviye yanıtları ve prognozları incelendi. Tüm olgular Miyastenia gravis tanısını klinik, farmakolojik ve elektrofizyolojik çalışmalar neticesinde aldı. Olgularımızda krizi tetikleyici bir enfeksiyon odağı mevcuttu. Miyastenik krizdeki olgular iki gruba ayrılarak, daha öncesinde Miyastenia gravis tanısı alanlar ile ilk klinik tablosu miyastenik kriz olarak başlayan olgular şeklinde değerlendirildi. Olgularımızın iki tanesinin Miyastenia gravis tanısı mevcuttu. Bir olgumuzda düzensiz ilaç kullanımı ve artan fiziksel stres, bir olgumuzda da ilaç dozunun azaltılmasına bağlı gelişen krize eşlik eden baziler arter tepe trombozu saptandı. Diğer olgumuz ise myastenik kriz olarak değerlendirilen tablo neticesinde yapılan incelemeler ile miyastenia gravis tanısı aldı. Miyastenik kriz tanılı olgularımızın hepsine intravenöz immünglobülin tedavisi uygulandı. Krizi ortaya çıkarabilecek sekonder nedenlerin saptanarak erken dönemde kontrol altına alındığı, entübasyon ihtiyacının kısa sürede ortadan kaldırıldığı ve medikal komplikasyonların gelişmemesi için etkin tedavi uygulanan olgularımızda kriz tedavisinin daha başarılı olduğu görüldü.

Myasthenic crisis: 3 case reports and review of the literature

Within the last year, records of three cases of patients who had episodes of a myasthenic crisis were reviewed. A crisis accompanied by other causes, treatment response and prognosis were analyzed. The diagnosis of myasthenia gravis was a result of clinical, pharmacological and electrophysiological studies. Patients had infection triggers. Our patients with myasthenic crisis were divided into two groups. Patients were treated as patients with the diagnosis of myasthenia gravis or the patients who first presented with myasthenic crisis. Two of our patients had a diagnosis of myasthenia gravis. In one of our patients, irregular drug usage and physical stress was determined. In one patient, the top of the basilar syndrome accompanied by a myasthenic crisis that occured because of a reduction in the patient's drug dose. Another case of myasthenic crisis was a patient who was diagnosed with myasthenia gravis previously. All of our patients with the diagnosis of myasthenic crisis took IVIG treatment. Controlling the secondary reasons that may cause the myasthenic crisis, short intubation period, and effective treatment to avoid medical complications proved to be more successful.

Kaynakça

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