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Related Concept Videos

Myasthenia Gravis: Diagnostic Tests01:15

Myasthenia Gravis: Diagnostic Tests

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Myasthenia gravis is an autoimmune condition affecting neuromuscular transmission, causing generalized weakness in skeletal muscles. Initial diagnoses rely on patients' signs, symptoms, and medical history. The challenge lies in distinguishing myasthenia from other muscular dystrophies. An important diagnostic feature is the significant improvement of symptoms after administering anticholinesterase inhibitors.
The edrophonium test is a diagnostic tool for myasthenia gravis. It involves...
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Myasthenia Gravis: Overview and Treatment01:20

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Myasthenia gravis is a neuromuscular transmission disorder characterized by weakness and increased fatigability of skeletal muscles. It is an autoimmune disease affecting approximately one in 2000 people, where antibodies against the α1 subunit of nicotinic acetylcholine receptors are produced.
These antibodies interfere with the function of the nicotinic receptors in three ways: by binding to the receptor and disrupting acetylcholine binding; by causing cross-linking of receptors which...
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Disorders of the Skeletal Muscle01:28

Disorders of the Skeletal Muscle

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The clinical conditions affecting the skeletal muscle tissue are broadly categorized as musculoskeletal and neuromuscular disorders.
Musculoskeletal disorders
Musculoskeletal disorders involve injuries and conditions affecting the skeletal muscles and associated connective tissues. These disorders can arise from acute biomechanical stresses or chronic overuse and can occur across different age groups. Common injuries include sprains, fractures, and muscular strains, often resulting from...
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Chemical Synapses01:26

Chemical Synapses

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Chemical synapses are specialized sites between two neurons or between a neuron and a non-neuronal cell like a muscle, glandular or sensory cell.
Because chemical synapses depend on the release of neurotransmitter molecules from synaptic vesicles to pass on their signal, there is an approximately one millisecond delay between when the axon potential reaches the presynaptic terminal and when the neurotransmitter leads to opening of postsynaptic ion channels. Additionally, this signaling is...
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Muscle Contraction01:10

Muscle Contraction

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In skeletal muscles, acetylcholine is released by nerve terminals at the motor endplate—the point of synaptic communication between motor neurons and muscle fibers. The binding of acetylcholine to its receptors on the sarcolemma allows entry of sodium ions into the cell and triggers an action potential in the muscle cell. Thus, electrical signals from the brain are transmitted to the muscle. Subsequently, the enzyme acetylcholinesterase breaks down acetylcholine to prevent excessive...
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Cross-bridge Cycle01:26

Cross-bridge Cycle

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As muscle contracts, the overlap between the thin and thick filaments increases, decreasing the length of the sarcomere—the contractile unit of the muscle—using energy in the form of ATP. At the molecular level, this is a cyclic, multistep process that involves binding and hydrolysis of ATP, and movement of actin by myosin.
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Utility of Dissociated Intrinsic Hand Muscle Atrophy in the Diagnosis of Amyotrophic Lateral Sclerosis
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Isolated Bilateral Triceps Weakness in Myasthenia Gravis.

Betül Özenç1, Kübra Işık2, Zeki Odabaşı3

  • 1Neurology Department, Gülhane Training and Research Hospital, Ankara, Turkey.

Acta Neurologica Taiwanica
|October 17, 2023
PubMed
Summary

This case study highlights a rare presentation of myasthenia gravis (MG) with dominant triceps muscle weakness. Early recognition of this unusual symptomology is crucial for accurate diagnosis and effective treatment of MG.

Keywords:
Myasthenia gravis (MG)limb repetitive nerve stimulation.triceps weakness

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Area of Science:

  • Neurology
  • Immunology

Background:

  • Myasthenia gravis (MG) is an autoimmune disorder affecting neuromuscular junctions, typically causing ocular, facial, or neck muscle weakness.
  • Selective or dominant triceps muscle weakness is an uncommon manifestation of MG.

Observation:

  • A 45-year-old male patient presented with initial diplopia and ptosis, later developing bilateral triceps weakness.
  • The patient had a history of thymectomy and was on pyridostigmine and prednisone treatment.
  • Repetitive nerve stimulation confirmed decremental responses in the triceps muscles.

Findings:

  • The case illustrates a rare form of myasthenia gravis characterized by predominant triceps muscle weakness.
  • Acetylcholine receptor antibodies were positive, confirming the autoimmune etiology.
  • The development of triceps weakness occurred despite established MG treatment and a decade of stability.

Implications:

  • Recognizing this rare MG presentation can prevent diagnostic delays and unnecessary investigations.
  • Prompt identification facilitates targeted treatment strategies for improved patient outcomes.
  • This case expands the understanding of clinical variability in myasthenia gravis.