Central Sleep Apnea Thought To Be A Result Of Strangulation As A Presenting Symptom Of Musk Positive Myasthenia Gravis
INTRODUCTION: Myasthenia Gravis (MG) is a chronic autoimmune neuromuscular disease characterized by the presence of autoantibodies against the skeletal muscle acetylcholine receptor (AchR), muscle-specific receptor tyrosine kinase (MuSK), or low density lipoprotein receptor related protein 4 (LRP4). It causes muscular weakness commonly affecting muscle groups that control eye and eyelid movement, facial expression, chewing, talking, and swallowing. Sleep disorders are a major causes of mortality in patients with neuromuscular diseases, yet the prevalence with MG is poorly documented in literature. An estimated 30% of MG patients will develop some degree of respiratory muscle weakness; with 15-20% of these patients requiring ventilator support
CASE DESCRIPTION: We present a case of a 27-year-old African American female that arrived to the ED after being choked and struck in the face by her partner. During her hospitalization she continued to have respiratory depression, intermittent somnolence and cognitive delays. Initial presentation was most consistent with anoxic brain injury secondary to the strangulation; but later she was diagnosed with central sleep apnea. She subsequently required assisted ventilation at night. Her complaints also highlighted a predominance of bulbar symptoms including ptosis, dysphagia and dysarthria. Further workup including Acetylcholine receptor antibodies was negative, but positive Anti-MuSK antibodies were noted. Following treatment with IVIG, prednisone, and Mesiton, the patient returned to work with significant improvements in both speech and strength.