| Identifier |
walsh_2016_s3_c4-1 |
| Title |
Eyes and Bowels Bottled Up - Presentation PPT |
| Creator |
Kristopher Kowal; Jonathan D. Trobe; Theodore T. Brown |
| Affiliation |
(KK) (JDT) Departments of Ophthalmology and Visual Sciences, Kellogg Eye Center; (JDT) Neurology; and (TTB) Pathology, University of Michigan |
| Subject |
Myasthenia Gravis; Dysautonomia; Intestinal Pseudo-Obstruction |
| History |
A 56 year-old man presented with diplopia and ptosis. Actually he was more concerned about severe constipation that had started about the same time. Abdominal x-rays had shown stool loading; laxatives had been ineffective. Our exam showed bilateral ptosis with complete ophthalmoplegia in both eyes. Pupils were normal, as was the rest of the ophthalmic examination. He had mild hypophonia but an otherwise normal neurologic exam, including intact muscle stretch reflexes. Acetylcholine receptor antibody titers were abnormal: binding 6.39 nmol/L (normal < 0.02nmol/L), striational 1:30270 (normal < 1:60), modulating 95% loss of function (normal 0-20%). To investigate his constipation, we performed abdominal CT, which showed dilated loops of small bowel without apparent obstruction. Within days of starting treatment with pyridostigmine (60mg 5x/day), his constipation was relieved, and CT showed resolution of the dilated bowel loops. But his eye signs persisted. |
| Disease/Diagnosis |
Myasthenia gravis with dysautonomic intestinal pseudo-obstruction and thymoma |
| Date |
2016-02 |
| References |
1. Vernino S, Cheshire WP, Lennon VA. Myasthenia gravis with autoimmune autonomic neuropathy. Auton Neurosci. 2001; 88:187-92. 2. Malhotra K, Georgiades IB, Davies J. Functional colonic obstruction in an adult as a presenting feature of thymoma. Ann R Coll Surg Engl. 2011; 96:61E-63E 3. Rakocevic G, Barohn R, McVey AL, Damjanov I, Morte PD, Vernino S, Lennon V. Myasthenia Gravis, Thymoma and Pseudo-obstruction. J Clin Neuromuscul Dis. 2003; 5:93-95. 4. Miglis MG, Racela R, Kaufmann H. Seropositive myasthenia and autoimmune autonomic ganglionopathy: Cross reactivity or subclinical disease? Auton Neurosci. 2011; 164:87-88. |
| Language |
eng |
| Format |
application/pdf |
| Format Creation |
Microsoft PowerPoint |
| Type |
Text |
| Source |
48th Annual Frank Walsh Society Meeting |
| Relation is Part of |
NANOS Annual Meeting Frank B. Walsh Sessions; 2016 |
| Collection |
Neuro-Ophthalmology Virtual Education Library: Walsh Session Annual Meeting Archives: https://novel.utah.edu/Walsh/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Rights Management |
Copyright 2016. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6tj1j82 |
| Setname |
ehsl_novel_fbw |
| ID |
179315 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6tj1j82 |
