scholarly journals Gastroparesis, Thymoma, and Asymptomatic Myasthenia: A Rare Clinical Scenario

2022 ◽  
Vol 13 (1) ◽  
pp. 27-32
Author(s):  
Consuelo Tamburella ◽  
Silvana Parisi ◽  
Sara Lillo ◽  
Giacomo Ferrantelli ◽  
Paola Critelli ◽  
...  
Keyword(s):  
Myasthenia Gravis ◽  
Delayed Gastric Emptying ◽  
Radical Surgery ◽  
Autonomic Failure ◽  
Abdominal Distension ◽  
Anterior Mediastinum ◽  
Sudden Onset ◽  
Clinical Scenario ◽  
Solid Mass ◽  
Acid Regurgitation

Background: Paraneoplastic gastroparesis is a gastrointestinal syndrome that rarely precedes a tumor diagnosis. To increase awareness of this rare clinical entity, we present a case of severe gastroparesis, which was later proven to be associated with a thymoma. Case report: A 55-year old man had the sudden onset of severe abdominal cramps and abdominal distension, early satiety with postprandial nausea, acid regurgitation, belching, and flatulence. He lost about 20 pounds. The physical and imaging examination revealed stomach distension, gastroparesis, and the presence of a solid mass in the anterior mediastinum. Radical surgery was performed to remove the thymoma and, given the high value of Mib-1, the patient was submitted to postoperative chest radiation therapy. After thymectomy, a diagnosis of paraneoplastic myasthenia gravis with subacute autonomic failure was made. Conclusion: Autoimmune gastroparesis should be considered as a potential paraneoplastic syndrome in patients with thymoma, myasthenia gravis, and delayed gastric emptying in the absence of mechanical obstruction.

Sudden Onset of Diplopia and a Skeletal Muscle Antibody

2021 ◽  
pp. 160-162
Author(s):  
John R. Mills
Keyword(s):  
Computed Tomography ◽  
Myasthenia Gravis ◽  
Patent Foramen Ovale ◽  
Time Course ◽  
Vision Loss ◽  
Sudden Onset ◽  
Foramen Ovale ◽  
Clinical Disorder ◽  
History Of ◽  
The Right

A 62-year-old man with a history of migraine came to the emergency department with sudden onset of horizontal diplopia and, subsequently, bilateral ptosis. He noted feeling unsteady when walking. He reported that the diplopia worsened throughout the day. He had a history of hepatitis C infection. He had some vision loss in his left eye, which was thought to relate to a retinopathy. He disclosed that he had a history of cold feet and had notably high arches. He had a pacemaker because of syncope attributed to sick sinus syndrome. Computed tomography angiography of the head and neck were ruled negative for intracranial stenosis, occlusions, or aneurysms. Computed tomography of the head indicated a tiny lacunar infarct in the right caudate head. Magnetic resonance imaging of the brain identified a tiny, periaqueductal, enhancing abnormality in the right midbrain that was thought to be likely ischemic, but there was some concern for a demyelinating or inflammatory lesion. Cerebrospinal fluid evaluation indicated an increased protein concentration. Serologic evaluation for myasthenia gravis striational antibodies were positive at a titer of 1:240. Serum protein studies indicated the presence of polyclonal hypergammaglobulinemia. Myasthenia gravis was effectively ruled out. Given the hyperacute time course, the patient’s clinical disorder was most probably explained by an ischemic stroke that affected the oculomotor nuclei regions causing ptosis and ophthalmoparesis. On follow-up, the patient was discovered to have a patent foramen ovale. Whether the patent foramen ovale was a contributing factor to the stroke is uncertain. The recurrence rate in this setting is thought to be low relative to other causes of stroke. Ultimately it was decided to not close the patent foramen ovale and to maintain the patient on clopidogrel and adult low-dose aspirin. The onset of diplopia is typically sudden, but this occurs exclusively with vascular pathologic processes. Diplopia that appears intermittently with diurnal variation suggests the possibility of a neuromuscular junction disease such as myasthenia gravis.

Guillain-Barré Syndrome

2019 ◽  
pp. 193-207
Author(s):  
Matthew J. G. Burford ◽  
Richard A. Lewis
Keyword(s):  
Differential Diagnosis ◽  
Immune Therapy ◽  
Treatment Options ◽  
General Pattern ◽  
Clinical Manifestations ◽  
Sudden Onset ◽  
Guillain Barre Syndrome ◽  
Clinical Scenario ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

This chapter begins by outlining the origin of Guillain-Barré syndrome (GBS). It looks at the epidemiology and antecedent events. It also considers clinical manifestations. The classic clinical scenario is one of acute, symmetric, progressive, ascending weakness, and areflexia, with or without sensory symptoms days to weeks after a preceding infection. Next differential diagnosis is examined. The differential diagnosis of GBS is quite broad and includes disorders leading to sudden onset of weakness. The general pattern of clinical involvement and medical history helps to hone the differential. Finally, the chapter looks at management of the syndrome and treatment options for various different groups, such as immune therapy.

Thymic epithelial tumors at University Federico II of Naples: A 30-year experience.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 7603-7603
Author(s):  
Carlo Buonerba ◽  
Piera Federico ◽  
Filomena Calabrese ◽  
Margaret Ottaviano ◽  
Lucia Nappi ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Myasthenia Gravis ◽  
Thymic Carcinoma ◽  
Radical Surgery ◽  
Sample Population ◽  
Tumor Diameter ◽  
Thymic Epithelial Tumors ◽  
Epithelial Tumors ◽  
Increased Risk ◽  
Thymic Carcinomas

7603 Background: According to the 2004 WHO classification, thymic epithelial tumors (TETs) comprise different histologies, including thymomas, thymic carcinoma, typical and atypical carcinoids. Histology classification of TETs has a dramatic impact on the prognosis and therapeutic strategy. We here review all TETs treated at our Institution over the past 30 years. Methods: Eligible patients had a pathologically confirmed TET and had at least one access at our Institution. Relevant demographic and clinical data were retrieved. An exploratory analysis was conducted using a step-wise model in patients with completely resected tumors to seek for factors predictive of recurrence after radical surgery. Results: One hundred and three patients with TETs were included in this retrospective analysis. Forty-three were female, sixty were male. Median age was 43 years (range 32-58). Forty-three patients had myasthenia gravis. Four had a thymic neuroendrocrine tumor, 19 had a thymic carcinoma, while the remaining had a thymoma. Forty-seven patients were alive at the time of analysis. Median overall survival was 5.85 years (range, 2.58-9.9). In the whole sample population, seventy-six patients had a completely resected tumor with clear pathological margins. In this sub-group of 76 patients (median age: 46, 35-55; 30 females, 46 males), 12 had a thymic carcinoma and 30 patients recurred after radical surgery. At multivariate analysis, which included age, sex, adjuvant chemotherapy, adjuvant radiotherapy, maximum tumor diameter, presence of myasthenia gravis and stage, the only factor significantly predictive of recurrence was tumor histology (odds ratio: 3,8182, 95% CI: 1,03 to 14,1; p = 0.04). Conclusions: We showed that patients with thymic carcinomas are at increased risk of recurrence after radical surgery independently on adjuvant chemotherapy/radiotherapy treatment. Additional therapeutic options are required in the adjuvant setting of completely resected thymic carcinomas.

Expecting the unexpected.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e14066-e14066
Author(s):  
Blessie Elizabeth Nelson ◽  
Adrian Gerard Murphy ◽  
Jacquelyn W. Zimmerman
Keyword(s):  
Myasthenia Gravis ◽  
Muscle Weakness ◽  
De Novo ◽  
Early Recognition ◽  
Compound Muscle Action Potential ◽  
Care Center ◽  
Tertiary Care ◽  
Sudden Onset ◽  
Shoulder Abduction ◽  
Myasthenic Crisis

e14066 Background: Myasthenia gravis is an autoimmune neuro-muscular disorder traditionally seen in bi-modal distribution in young women or older men. Discovery of immunotherapy has brought hope in survival outcomes for patients with malignant melanoma, lung, renal and head/neck cancers but it also opens Pandora’s box of immune-related toxicities for which early recognition and appropriate clinical management are paramount. Here we describe a case of immunotherapy induced myasthenia gravis de novo. Methods: A 77-year-old man with HPV+ stage IVA squamous cell carcinoma of the tongue presented with sudden onset orthopnea and dyspnea on exertion for the past day. One week ago, he received his second cycle of nivolumab as part of his neoadjuvant therapy. He was seen at an outside hospital and was found to be acute hypercapnic respiratory failure and placed on BiPAP. He was started on antibiotics for community-acquired pneumonia with levofloxacin and doxycycline and transferred to a tertiary care center for further management. On further evaluation, he endorsed diplopia, blurry vision, fluctuating muscle weakness that is worse at the end of the day, change in voice and proximal muscle weakness. His exam was consistent with bilateral ptosis, weak hip flexion and shoulder abduction, positive sniff test and poor vital capacity and negative inspiratory force values suggestive of impending respiratory and diaphragmatic failure secondary to myasthenic crisis. He was admitted to the ICU and placed on BiPAP and frequent NIF and VC monitoring. He was started on pyridostigmine but showed no clinical improvement on day 1 and hence was initiated on plasmapheresis from day 2 for a total of 10 days. Results: Investigations showed positivity of Ach-R modulating and binding and blocking antibodies with negative voltage gated calcium channel antibodies. EMG revealed decrement of the compound muscle action potential in the repetitive stimulation test indicative of myasthenia gravis. He responded well to the above treatment and underwent successful left partial glossectomy and weaned off mechanical ventilation and has been cancer free so far. He is doing well on maintenance prednisone and pyridostigmine. Conclusions: There is a significant 30.4% MG-specific-related mortality due to immunotherapy alone which this case demonstrates the importance of vigilance and early detection for effective treatment and management. It highlights need for the oncological world and our colleagues in various other disciplines of healthcare to identify and mitigate the effects of immunotherapy which has become our hope in beating cancer.

scholarly journals THYMOMA: A RARE CAUSE OF MEDIASTINAL TUMOR IN CHILDREN

2016 ◽  
Vol 65 (4) ◽  
pp. 382-385
Author(s):  
Andreea Durlan ◽  
◽  
Cristina Oana Marginean ◽  
Maria Despina Baghiu ◽  
Alina Grama ◽  
...  
Keyword(s):  
Pediatric Cardiology ◽  
Specific Treatment ◽  
Anterior Mediastinum ◽  
Solid Mass ◽  
Partial Removal ◽  
Mediastinal Tumors ◽  
Cardiology Clinic ◽  
Diagnostic Difficulties ◽  
Vascular Structures ◽  
Thymic Neoplasm

Thymoma is a thymic neoplasm composed of epithelial cells, rarely seen in children. Approximately two-thirds of mediastinal tumors in children are asymptomatic. The diagnosis is suspected following the compression of the tumor mass on the airways. We present the case of a male patient, age 7 years and 8 months, who presented at the emergency room accusing fatigue at rest or minimum effort, dry cough, intense dyspnea, orthopnea, tachypnea, chest pain, being transferred to the Pediatric Cardiology Clinic in Tirgu Mures with the following diagnoses: fluid pericarditis, right pleural effusion and cardiac tamponade. Chest computer tomography examination is carried out, describing a solid mass of 100/89/111 mm in the anterior mediastinum, partially incorporating the thymus and the vascular structures of the middle mediastinum. Pericardectomy is practiced with partial removal of the tumor and extensive tumor cytoreduction and the histopathologic examination is B3 Thymoma. Specific treatment is initiated according to the Tymoma VENUTA protocol, followed by adjuvant radiotherapy, with clinical and radiological remission. The particularity of the case is the fact that thymoma is a rare tumor on the patient’s age, creating diagnostic difficulties, has no complications during treatment, with favorable evolution, with clinical and radiological remission at 1.9 years after.

scholarly journals HYPERDENSE BASILAR ARTERY – EARLY SIGN OF STROKE

JMS SKIMS ◽  
2020 ◽  
Vol 23 (1) ◽  
pp. 46-47
Author(s):  
Mohammad Masood ◽  
Akshit Kumar ◽  
Omair Ashraf Shah ◽  
Feroz Shaheen
Keyword(s):  
Emergency Department ◽  
Facial Nerve ◽  
Basilar Artery ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Sudden Onset ◽  
Posterior Circulation ◽  
Clinical Scenario ◽  
Posterior Circulation Stroke ◽  
Basilar Occlusion

Hyperdense artery sign is presumed to represent acute thrombus or clot, and is an early indicator of posterior circulation stroke. This sign if detected, in proper clinical scenario can help the clinician to detect the basilar occlusion and to intervene early. We are presenting a case of 30 yr. old female, normotensive, nondiabetic presented with sudden onset focal left sided seizure, central vertigo, diplopia and decreased vision in left eye to emergency department. On examination, ptosis and anisocoria, Left facial nerve palsy. Patient was advised NCCT Head, which showed hyperdense basilar artery , seen retrospectively after MRI.    

Computed tomography of the anterior mediastinum in myasthenia gravis. A radiologic-pathologic correlative study.

Radiology ◽  
1982 ◽  
Vol 142 (1) ◽  
pp. 135-141 ◽  
Author(s):  
G T Fon ◽  
M E Bein ◽  
A A Mancuso ◽  
J C Keesey ◽  
A R Lupetin ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Myasthenia Gravis ◽  
Anterior Mediastinum ◽  
Correlative Study

scholarly journals Evaluation of extended thymectomy approaches based on residual fat tissue

2020 ◽  
Author(s):  
Mitsuteru Yoshida ◽  
Masao Yuasa ◽  
Kazuya Kondo ◽  
Mitsuhiro Tsuboi ◽  
Naoya Kawakita ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Myasthenia Gravis ◽  
Three Dimensional ◽  
Median Sternotomy ◽  
Operation Time ◽  
Anterior Mediastinum ◽  
Fat Tissue ◽  
Extended Thymectomy ◽  
Residual Rate ◽  
Advantages And Disadvantages

Abstract OBJECTIVES This study analysed the patterns of extraction ranges, characteristics, advantages and disadvantages of median sternotomy (MS) and subxiphoid (SX) approaches for extended thymectomy. METHODS This study included patients with anterior mediastinum tumour and myasthenia gravis who underwent extended thymectomy at our institution between 2015 and 2018. There were 5 MS and 6 SX extended thymectomy surgeries with the VINCENT software. On preoperative computed tomography, the thymus area and fat tissue surrounding the thymus, which were planned for extraction, were traced using VINCENT (Ver. 4.0). We then constructed three-dimensional images and calculated the volumes. Evaluation of the extended thymectomy approach based on the residual fat tissue was required to determine the area of extended thymectomy. RESULTS No significant differences in operation time (min) [SX: 197.3 ± 34.0, MS: 206.6 ± 91.4, drainage duration (days), SX: 2.2 ± 1.0, MS: 2.2 ± 0.4, hospital stay (days), SX: 11.8 ± 1.2, MS: 13.4 ± 2.1, residual rate (%), SX: 29.9 ± 17.5, MS: 58.7 ± 18.0 (P = 0.0519)] were observed between the 2 groups. Bleeding was significantly lower for SX than for MS. The residual rate was lower for SX than for MS. CONCLUSIONS Considering the amount of the residual fat tissue, the SX approach allows an adequate dissection area for extended thymectomy compared with the MS approach.

scholarly journals Perinephric pseudocyst in a cat: management by ultrasound-guided drainage

2018 ◽  
Vol 68 (2) ◽  
pp. 245
Author(s):  
K. K. ADAMAMA-MORAITOU ◽  
D. PARDALI ◽  
I. VAFIADIS ◽  
M. N. PATSIKAS ◽  
N. N. PRASSINOS
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Abdominal Distension ◽  
Sudden Onset ◽  
Ultrasound Guided ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Mild Anemia ◽  
Biochemical Testing ◽  
Moderate Chronic Kidney Disease

A 15-year-old castrated DSH cat was presented with a sudden onset of abdominal distension of 10 days duration. Polyuria/polydipsia, sporadic vomiting and weight loss were also mentioned by the owners. Distension of the cranial abdomen was observed on admission, and two smooth masses were palpated in the abdomen. Mild anemia and azotemia were detected on hematological and biochemical testing. Plain lateral and dorsoventral radiographic views of the abdomen were compatible with renomegaly. Ultrasonography revealed the presence of fluid surrounding both kidneys, and analysis of the accumulated fluid confirmed the diagnosis of bilateral subcapsular transudative perinephric (perirenal) pseudocysts. The precise etiology of pseudocysts formation in our cat could not be identified. Emphasis is placed on their development, due to the coexisting chronic kidney disease, but also to other causes. Although surgical or laparoscopical resection of the cyst wall is generally recommended, owners of this cat elected periodical ultrasound-guided drainage of the perinephric fluid. This might be a reasonable decision, due to its advanced age and the macroconcurrent moderate chronic kidney disease. The long term outcome was favorable, with permanent remission of the perinephric pseudocysts after only three evacuations. The cat died, approximately 20 months after the initial presentation, due to deterioration of chronic kidney disease, and perinephric pseudocysts could not be detected clinically at that time.

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