Hypotension as a first presentation of myasthenia gravis in an elderly patient scheduled for cervical disc surgery: a case report

Abstract

Myasthenia gravis presents with progressive skeletal muscle weakness. The disease can affect any group of muscles, along with the proximal limb and neck musculature. Elderly patients, especially those over 60 y of age, frequently face extensive delays in diagnosis, or are misdiagnosed, as the symptoms may be erroneously attributed to different other causes frequently seen in this age group, such as degenerative joint disease, disk herniation, osteoporotic vertebral fractures, or metastases. We present a case of a 61-year-old male patient with significant medical records of hypertension, who presented with neck pain for a few months, posted for cervical disc surgery at C6-7  with cage fixation. Two attempts for general anesthesia induction were complicated by severe hypotension. He was evaluated with low-frequency repetitive stimulation, Acetyl-choline receptor antibody, and P/Q calcium channel antibodies. The low-frequency Repetitive Nerve Stimulation (RNS) showed a severe reduced response that was corrected after rest, which was consistent with the diagnosis of myasthenia gravis.

Key words: Myasthenia; Pain, Neck; Hypotension; Weakness

Citation: Seyam SH, Ali MA, Razein H, Elkousy I, Schandran SB. Hypotension as a first presentation of myasthenia gravis in an elderly patient scheduled for cervical disc surgery: a case report. Anaesth. pain intensive care 2023;27(6):763−767; DOI: 10.35975/apic.v27i6.2351

Received: July 08, 2023; Revised: September 16, 2023; Accepted: October 09, 2023