NASRAH N.

MUSA
NEUROLOGY
LDCU-COM

MYASTHENIC CRISIS VS CHOLINERGIC CRISIS

Myasthenic Crisis Cholinergic Crisis

•an exacerbation of the myasthenic symptoms
caused by undermedication with
anticholinesterases
Priority for management is to maintain
adequate respiratory function.
Cholinesterase inhibiting drugs ineffective
during crisis and cause increase in
secretions
•an acute exacerbation of muscle weakness
caused by overmedication with cholinergic
anticholinesterase drugs
Muscle twitching to the point of respiratory
compromise
Priority to maintain respiratory function
Symptoms improve with anticholinergic
medications (atropine)

Possible triggers Possible triggers

o Not taking your myasthenia gravis o Medications for the treatment of
medication myasthenia gravis or glaucoma,
o Tapering off drugs that control your including pyridostigmine
immune system o Ingestion or exposure to insecticides,
o Medications like antibiotics, anti-seizure pesticides, or herbicides
drugs, or steroids like prednisone o Exposure to nerve gas
o Pregnancy o Reversal of neuromuscular blockage
o Giving birth
o Premenstrual syndrome (PMS)
o Stress
o Not getting enough sleep
o Pain
o Surgery
o Extreme hot or cold weather

SIGN AND SYMPTOMS SIGN AND SYMPTOMS

Eye muscles Nicotinic toxicity

Drooping of one or both eyelids (ptosis) Muscle weakness
Double vision (diplopia) Fasciculations
Face and throat muscles Muscarinic toxicity
Impair speaking. Diaphoresis
Cause difficulty swallowing Excessive tearing
Affect chewing. Increased oral and pulmonary secretions
Change facial expressions. Nausea and vomiting
Neck and limb muscles Diarrhea
Weakness in your neck, arms and legs. Bradycardia
Weakness in your legs can affect how you walk.

Weak neck muscles make it hard to hold up
your head.
Myasthenic Emergency Crisis:
 you have to hold the meds (increase
secretions)
 To treat a myasthenic crisis, you’ll need
emergency treatment at the hospital.
Doctors will intubate you, which means
they’ll insert a tube into your airways.
 Need to remove the secretions.
 Maintain respiratory function.
 Tensilon test is performed. (will help
improve muscle tone)
Cholinesterase-inhibiting drugs are withheld
because they increase respiratory secretions
and are usually ineffective for the first few days
after the crisis begins.
EVALUATION
o Chest X-ray and lung ultrasound
(exclude other lung disease)
o Forced vital capacity (FVC)
o Electrolytes (including Ca/Mg/Phos),
CBC with differential
o Beta-HCG if pregnancy possible
o Infectious workup or TSH level if
symptoms of infection or thyroid disease
NASRAH N. MUSA
NEUROLOGY
LDCU-COM
Cholinergic Emergency Crisis
 Regardless of the etiology of cholinergic
crises, the core principle in stabilization
is ABC: Airway, Breathing, and
Circulation.
 Anticholinergic drugs are withheld while
the client is maintained on a ventilator.
 Two types of antidotes are used for a
cholinergic crisis: atropine and oximes.
 Atropine may be given and repeated, if
necessary. Dries you up.
 Observe for thickened secretions due to
the drugs.
 Improvement is usually rapid after
appropriate drugs have been given.
EVALUATION
o Detailed History taking and Physical
Examination
o CBC
o ECG
o Head CT Scan
o RBC Cholinesterase activity