Ice pack test—an useful bedside test to diagnose myasthenia gravis

Cheo, Seng Wee; Low, Qin Jian; Mow, W C; Chia, Yuen Kang

doi:10.1093/qjmed/hcy284

Cited by 3 publications

(2 citation statements)

References 4 publications

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“…Ice pack test can be accomplished in 2-5 minutes and ptosis should be evaluated at baseline and then checked after 5 minutes, if there is an improvement of > 2 millimeters then it is considered positive [5]. Literature has also reported the prior use of this test for myasthenic diplopia and ptosis in cases with ocular myasthenia gravis [6].…”

Section: Discussionmentioning

confidence: 99%

Selective Type 2 Respiratory Failure Followed by Ocular Myasthenia Gravis Diagnosed by Ice Pack Test: A Case Report

Dave

Desai

Checker

et al. 2019

Cureus

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Myasthenia gravis is an autoimmune neuromuscular disorder that can present with skeletal muscle involvement, ocular muscles involvement and can progress to respiratory muscle paralysis. Here, we present a unique case of type 2 respiratory failure due to myasthenia gravis with the delayed ocular presentation. A 46-year-old female patient presented to the outpatient clinic with complaints of dyspnea. On further evaluation, she was found to be hypercapnic on arterial blood gas analysis with no muscular weakness in any of the limbs. The patient further progressed to ocular symptoms. With the use of an ice pack test, a bedside test for improvement of ptosis, the patient was diagnosed with myasthenic ptosis preventing further progression of type 2 respiratory failure and intubation. With this case report, we emphasize the critical role of such simple bedside test in timely diagnosis and management of myasthenia gravis while awaiting the final results.

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Section: Discussionmentioning

confidence: 99%

Selective Type 2 Respiratory Failure Followed by Ocular Myasthenia Gravis Diagnosed by Ice Pack Test: A Case Report

Dave

Desai

Checker

et al. 2019

Cureus

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“…The ice pack test is employed in those patients where edrophonium test is not indicated. 11 Electrophysiological tests can be performed for the diagnosis of MG. Single fiber electromyography is considered to be the most effective test where action potentials of individual nerve fibers can be identified.…”

Section: Clinical Features and Diagnosis Of Myasthenia Gravismentioning

confidence: 99%

Management of Myasthenia Gravis

Venkataramaiah

Sriganesh

2019

Journal of Neuroanaesthesiology and Critical Care

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Myasthenia gravis (MG) apart from Guillain–Barré syndrome is one of the most common disorders presenting as respiratory failure secondary to muscle weakness in the modern world. MG is also one of the most researched and reasonably well understood autoimmune disorder of mankind. From the description of early cases of MG to the current day understanding, the progress in the management and therapeutics has advanced significantly. Diagnosis of MG can be accurately done either with traditional tests such as the edrophonium test or by advanced nerve conduction studies. Presence of demonstrable circulating autoantibodies against the acetyl choline receptors, muscle-specific tyrosine kinase, involvement of B and T cells in the pathogenesis, and tomographic evidence of the enlarged thymus gland in certain patients have led to designing specific treatment strategies. Removal of the circulating autoantibodies as much as possible by plasmapheresis supported by anticholinesterases and immunosuppression are the mainstay of targeted therapy. The advent of newer immunosuppressant drugs such as rituximab which targets the CD20 protein present on the surface of B cells and tacrolimus which is an interleukin 2 inhibitor has improved the therapeutic armamentarium of the physician. These agents in combination with time tested medications such as steroids and antimetabolites have rendered faster remission rates and improved outcomes in MG crisis. This article outlines the basic pathophysiology, specific and supportive management strategies in patients presenting with MG with or without crisis.

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