Myasthenic crisis: Diagnostic and therapeutic approach

Myasthenic crisis is defined as an acute exacerbation of myasthenia gravis requiring respiratory support or delay of extubation after surgery due to the inability to wean off the ventilator. The prevalence of myasthenic crisis is increasing mainly due to more awareness in the medical community. Most patients will have an identifiable trigger, although a small percentage of patients will have no inciting factor. Respiratory compromise is the key feature that may lead to mortality and needs to be addressed in a timely fashion. The diagnosis can be challenging in the acute setting and the threshold for suspicion should be low. The patient should be admitted to a neurointensive care unit and close attention should be provided to pulmonary mechanics. Immunotherapy such as plasma exchange or human intravenous immunoglobulin should be initiated as soon as possible. Long term management can be initiated in the neurointensive care unit setting once the patient is stable.