A Mirror of
Hospital Practice
A CASE OF MYASTHENIA
GRAVIS
By M. HATANGDI, m.ii, b.s., d.t.m. Lady Jackson Hospital, Dohad A. U., an elderly Muslim male, aged 50 years, an armature winder of the electric department) was admitted to the hospital on 30th May, 1949, for investigation. The history was that for the last 18 months he had been noticing an increasing degree weakness and tiredness of the upper eyelids and the shoulders. This weakness started first the right upper eyelid and later on spread on to the left eyelid and subsequently to the shoulders. On admission the symptoms were felt more in the right upper eyelid and the left shoulder. He would start the day well but as it wore on, the eyelids Avould start drooping down gradually and it required an ever-increasing effort to keep the eyes open; finally he had to tilt the head back and see with downward slanting vision when effort could no longer overthe ptosis. At first he used to see come 1 double ' but now the diplopia has disappeared. His co-workers used to remark about his ' falling asleep while at Avork'. Sometime later he noted that the shoulders, the left one, would start aching and drooping down and a feeling of fatigue and weakness would make it increasingly difficult to lift the shoulders and use the arms. Early in the da} he could brace up the shoulders with slight effort but towards the end they would droop down in spite of all efforts and the feeling of weakness in the upper extremities would make it very difficult for him even to shake hands with people-
oj
particularly
Nov., 1949]
AMOEBIC VAGINITIS
:
BALASUBRAHMANYAN
He complained of slight general weakness and lassitude but the areas of marked weakness were strictly and definitely localized. One thing he ?ad learnt by experience, was that these symptoms of fatigue paralysis came on after he '
'
had been at work for some time and that they tended to disappear on rest?the longer the period of rest the more refreshed and energetic would he feel. He had reported sick
Previously too, but the true cause was missed and he was treated for eye strain with glasses, lo.r general debility with tonics and for neuralgia wjth vitamin Bx and vitamin B complex?all with doubtful relief. The thing that brought to this hospital was a rather sudden onset ?: weakness of the lower jaw four days pre} 10Usly. He felt a rapidly increasing difficulty 111 chewing betel leaf as was his wont after meals, and in swallowing it. His friends and relatives remarked that during conversation, after a winle, his speech would get slow, slurred and "distinct and he himself would find the tongue 00 freavy to articulate and talk freely.
fm
u|d
Kxcepting
the betel leaf he had no addictions. history or evidence of any specific ls?ase nor of any illness that usually cause central or peripheral nervous diseases. There ,a* 1U) history of any neuro or myopathic dis!hties in the family on either side. '>ore was
110
examination there was no evidence of any oci'ine disorder or persistent thymus. The build and health were good, and the Se and blood pressure were normal. a slight intention tremor of the left j and, nothing abnormal was noted in the and muscular systems. The occurrence ' of the muscles of the eyej: j fatigue paralysis and shoulders was tongue, deglutition 0 ? onfirmed by simple tests evolved to tire out the cular muscles concerned. Thus the ptosis, dysphagia, etc., were all found to be nuine- It was also noted that prolonged rest (i.
Jf^ral
barring
of1?'?11?
U ^ysarthria, these paralytic symptoms to disappear. j-j u|ec' laet the patient himself remarked he had ?
as
refreshed and energetic as in tl? hospitalso for some months; evidently the was beneficial, routine urine e! 0r9ecl restrevealed i
Though n0ai^lna^0n Wassermann abnormality. test done due to 1 ^ahn ^ac^ities and electrical reactions could no
or
n t snffi
was
k?^
c^0ne> the clinical findings were deemed characteristic to warrant the diag.Clently n of myasthenia gravis. 6 as well as parenterally ^-as 01'ally .g*Yen Dh Jsostigmine salicylate in full dosage combined tp-t fP^drine and atropine as a therapeutic 7~ut with disappointingly little effect. ini^r^1' ^le test was repeated with a prostigmin
r11' resil^ting
in
dramatic confirmation of All the symptoms of Para^rs^s \ which had been intentionally on before the injection, disappeared as y magic within a few minutes of the adminisation of the drug.
tli e ,
?
a
clmical diagnosis.
bi,a (jUght
& CHERIYAN
501
He was duly discharged and advised further treatment with prostigmin, in conjunction with ephedrine and atropine, at home and to come for periodical observation as an out-patient. When seen a few days ago he seemed quite happy and normal and said that he no longer had the old symptoms. I am grateful to the Chief Medical Officer and the District Medical Officer, Dohad, B. B. & C. I. Railway, for permission to report the above case.
Hospital Practice
A CASE OF MYASTHENIA
GRAVIS
By M. HATANGDI, m.ii, b.s., d.t.m. Lady Jackson Hospital, Dohad A. U., an elderly Muslim male, aged 50 years, an armature winder of the electric department) was admitted to the hospital on 30th May, 1949, for investigation. The history was that for the last 18 months he had been noticing an increasing degree weakness and tiredness of the upper eyelids and the shoulders. This weakness started first the right upper eyelid and later on spread on to the left eyelid and subsequently to the shoulders. On admission the symptoms were felt more in the right upper eyelid and the left shoulder. He would start the day well but as it wore on, the eyelids Avould start drooping down gradually and it required an ever-increasing effort to keep the eyes open; finally he had to tilt the head back and see with downward slanting vision when effort could no longer overthe ptosis. At first he used to see come 1 double ' but now the diplopia has disappeared. His co-workers used to remark about his ' falling asleep while at Avork'. Sometime later he noted that the shoulders, the left one, would start aching and drooping down and a feeling of fatigue and weakness would make it increasingly difficult to lift the shoulders and use the arms. Early in the da} he could brace up the shoulders with slight effort but towards the end they would droop down in spite of all efforts and the feeling of weakness in the upper extremities would make it very difficult for him even to shake hands with people-
oj
particularly
Nov., 1949]
AMOEBIC VAGINITIS
:
BALASUBRAHMANYAN
He complained of slight general weakness and lassitude but the areas of marked weakness were strictly and definitely localized. One thing he ?ad learnt by experience, was that these symptoms of fatigue paralysis came on after he '
'
had been at work for some time and that they tended to disappear on rest?the longer the period of rest the more refreshed and energetic would he feel. He had reported sick
Previously too, but the true cause was missed and he was treated for eye strain with glasses, lo.r general debility with tonics and for neuralgia wjth vitamin Bx and vitamin B complex?all with doubtful relief. The thing that brought to this hospital was a rather sudden onset ?: weakness of the lower jaw four days pre} 10Usly. He felt a rapidly increasing difficulty 111 chewing betel leaf as was his wont after meals, and in swallowing it. His friends and relatives remarked that during conversation, after a winle, his speech would get slow, slurred and "distinct and he himself would find the tongue 00 freavy to articulate and talk freely.
fm
u|d
Kxcepting
the betel leaf he had no addictions. history or evidence of any specific ls?ase nor of any illness that usually cause central or peripheral nervous diseases. There ,a* 1U) history of any neuro or myopathic dis!hties in the family on either side. '>ore was
110
examination there was no evidence of any oci'ine disorder or persistent thymus. The build and health were good, and the Se and blood pressure were normal. a slight intention tremor of the left j and, nothing abnormal was noted in the and muscular systems. The occurrence ' of the muscles of the eyej: j fatigue paralysis and shoulders was tongue, deglutition 0 ? onfirmed by simple tests evolved to tire out the cular muscles concerned. Thus the ptosis, dysphagia, etc., were all found to be nuine- It was also noted that prolonged rest (i.
Jf^ral
barring
of1?'?11?
U ^ysarthria, these paralytic symptoms to disappear. j-j u|ec' laet the patient himself remarked he had ?
as
refreshed and energetic as in tl? hospitalso for some months; evidently the was beneficial, routine urine e! 0r9ecl restrevealed i
Though n0ai^lna^0n Wassermann abnormality. test done due to 1 ^ahn ^ac^ities and electrical reactions could no
or
n t snffi
was
k?^
c^0ne> the clinical findings were deemed characteristic to warrant the diag.Clently n of myasthenia gravis. 6 as well as parenterally ^-as 01'ally .g*Yen Dh Jsostigmine salicylate in full dosage combined tp-t fP^drine and atropine as a therapeutic 7~ut with disappointingly little effect. ini^r^1' ^le test was repeated with a prostigmin
r11' resil^ting
in
dramatic confirmation of All the symptoms of Para^rs^s \ which had been intentionally on before the injection, disappeared as y magic within a few minutes of the adminisation of the drug.
tli e ,
?
a
clmical diagnosis.
bi,a (jUght
& CHERIYAN
501
He was duly discharged and advised further treatment with prostigmin, in conjunction with ephedrine and atropine, at home and to come for periodical observation as an out-patient. When seen a few days ago he seemed quite happy and normal and said that he no longer had the old symptoms. I am grateful to the Chief Medical Officer and the District Medical Officer, Dohad, B. B. & C. I. Railway, for permission to report the above case.
