Which physical findings are characteristic of severe myasthenia gravis?

Updated: Sep 20, 2018
  • Author: William D Goldenberg, MD; Chief Editor: Andrew K Chang, MD, MS  more...
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Severe exacerbations of myasthenia gravis may present dramatically and should be considered a true neurological emergency. [6] Findings can include the following:

  • Facial muscles may be slack, and the face may be expressionless

  • The patient may be unable to support his or her head, which will fall onto the chest while the patient is seated

  • Jaw is slack

  • Voice has a nasal quality

  • Body is limp

  • Gag reflex is often absent, and such patients are at risk for aspiration of oral secretions [9]

  • Respiratory distress

The patient's ability to generate adequate ventilation and to clear bronchial secretions is of utmost concern with severe exacerbations of myasthenia gravis.

Inability to cough leads to an accumulation of secretions; therefore, rales, rhonchi, and wheezes may be auscultated locally or diffusely. The patient may have evidence of pneumonia (ie, fever, cough, dyspnea, consolidation).

The patient may appear anxious, with rapid and shallow breathing. Paradoxical chest movements due to diaphragmatic weakness may be present. [5]

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