THE MANAGEMENT AND OUTCOME OF PATIENTS WITH MYASTHENIA-GRAVIS TREATEDACUTELY IN A NEUROLOGICAL INTENSIVE-CARE UNIT

The management and clinical course of patients with myasthenia gravis admitted to a neurological intensive therapy unit (ITU) over a 66 mont h period were reviewed. Twenty-seven patients were admitted in myasthe nic crisis, eight of whom had multiple admissions. One patient had a c holinergic crisis and a further patient an acute myocardial infarction . A specific aetiological factor precipitating myasthenic crisis was i dentified in 19 instances: infection (8), reduction in medication (5), menstruation (4), and steroid administration (2). Thirteen patients w ith crisis had had a previous thymectomy, six with thymoma. Twenty-thr ee out of 35 (66%) patients admitted in crisis required intubation; ni ne subsequently needed a tracheostomy. Twenty-nine patients received p lasma exchange and seven intravenous immunoglobulin. Four patients in myasthenic crisis died in ITU [adult respiratory distress syndrome (1) , disseminated intravascular coagulation and cytomegalovirus (CMV) pne umonitis (1), cardiac failure (1) and multiple organ failure (1)]. App ropriate management of myasthenia gravis requires the easy availabilit y of specialised neuro-intensive care facilities. (C) 1998 Rapid Scien ce Ltd.