What are the symptoms of myasthenia gravis?

Typical symptoms of myasthenia gravis are:

Drooping eyelids (eyelids) in one or both eyes are commonly known as "drooping eyelids".

Strabismus or diplopia. There is a double vision when you see things with both eyes, and you have to close one eye to see clearly.

Dysphonia. Speech is slurred, soft, and nasal.

Difficulty swallowing. Tends to choke when eating, drinking, or swallowing pills. Sometimes the water you try to swallow will come out of your nostrils.

Difficulty chewing. Halfway through a meal, you can't chew anymore, especially if you're eating something that's hard to chew like steak.

Facial expressions are lacking, and smiles are gone.

Proximal limb weakness. Unable to lift shoulders or hands, it is difficult to make fists, tilt heads, stand up, or climb stairs.

Shortness of breath and weak cough. When respiratory muscles are affected, a crisis of muscle weakness occurs, which can be fatal in severe cases.

Symptomatic presentation varies widely between patients, and some people may have only local eye muscle weakness; And someone may have muscles all over the body.

When a muscle group is used frequently, the symptoms in this area will worsen, which can be relieved by resting for a while, and then worsening when used again, and so on. However, myasthenia gravis symptoms can get worse over time, usually reaching a severe level within a few years of onset.

For patients with myasthenia gravis, the eyelids are sagging and drooping at first, and the eye movement is impaired, and then it will gradually affect the limbs, and the whole body will feel fatigue and fatigue, and in severe cases, it will be difficult to lift up the stairs. There will be a shadow later.

Clause. 1. Symptoms of fatigue. The main symptom of myasthenia gravis is fatigue from the outsider's point of view, the patient has no particularly obvious discomfort symptoms, but the patient himself can feel that he is often weak, and some of the most basic actions, such as carrying things, going up stairs, etc., cannot be completed independently; If it's more serious, there's no way to even squat down and get up again, and you need to get help from others.

Clause. 2. Symptoms of double vision. When the patient's body has myasthenia gravis, vision will also be affected, mainly manifested by double vision of the eyes and more frequent blinking.

The main manifestation is that when you put on clothes, you can't see the clothesline clearly, it is obviously a rope but you will see a lot of ropes, and even scratch the air when you touch it with your hands; If it is more severe, symptoms of strabismus may occur.

Clause. 3. Symptoms of crooked neck. When patients have myasthenia gravis, they will have a crooked neck and head in the next life, and they have no feelings, which is a subconscious behavior.

If the neck is crooked for a long time, it may affect the spine problems, so when the friends around you find that they have a crooked neck, you must go to the hospital for a check-up in time and **.

Clause. Fourth, the symptoms of breathlessness and difficulty in breathing. When myasthenia gravis is more severe, the patient will have symptoms of dyspnea, because myasthenia gravis has involved the respiratory muscles, so in this case, the respiratory muscles will have symptoms of weakness, and it will cause dyspnea.

What are the symptoms of myasthenia gravis? The most common presenting symptoms of myasthenia gravis are ptosis and diplopia in both eyes. Patients may also have muscle weakness in the extraocular muscles, laryngeal muscles, or extremities alone at the beginning of the disease.

The main symptoms are as follows:

Ptosis of the upper eyelid: this is caused by paralysis of one or both extraocular muscles, which may be accompanied by strabismus and diplopia at the same time.

Dysphagia and chewing: This is caused by the involvement of the facial and throat muscles, and at the same time, there will be an indifferent expression, a wry smile, continuous chewing weakness, choking on water, and more laborious swallowing of chewed food when eating;

Hoarseness: This is also caused by the involvement of the facial and throat muscles, which can be accompanied by nasal speech, dysphonia, and unclear pronunciation when speaking;

Difficulty raising head: when the sternocleidomastoid muscle and trapezius muscle are involved, it manifests as neck weakness, difficulty in raising the head, weakness in turning the head and shrugging the shoulders;

Weakness of the arms and legs: The muscles of the limbs are affected by proximal weakness, which is manifested as difficulty in raising the arms, combing the hair, and climbing stairs, but the tendon reflexes are usually unaffected and the sensation is normal;

Dyspnea: Respiratory muscle involvement often leads to adverse consequences, and medical attention should be sought as soon as possible if you experience difficulty breathing;

Morning and evening severity: this is a characteristic of the symptoms of the disease, i.e., daily fluctuations, muscle weakness that worsens after exertion in the afternoon or evening and lessens after morning or rest.

In some patients, when the respiratory muscles are affected, the generalized muscle contraction weakness or even muscle weakness occurs in the short term. Myasthenic crisis refers to the dangerous phenomenon that the patient suddenly develops severe dyspnea under the influence of a certain trigger, and the patient is unable to breathe normally. Once it occurs, patients need to be presented to the emergency department quickly, and myocardial involvement can occasionally occur, which can lead to sudden death.

Predisposing factors include respiratory tract infections, surgery (including thymectomy), stress, and systemic diseases.

Myasthenia gravis symptoms tend to fluctuate, worsen after exertion in the afternoon or evening, and lessen after getting up in the morning and resting, that is, mild in the morning and heavy in the evening. When respiratory muscles are affected, coughing, weakness, or even dyspnea occur, ventilator-assisted ventilation is required.

1. Pathological fatigue of affected skeletal muscle: generally insidious onset, manifested as aggravation of muscle weakness after activity, alleviation after rest, and mild morning and evening heaviness.

2. Distribution and performance of affected muscles: all skeletal muscles can be affected, and most of the muscles innervated by cranial nerves are the first to be affected. The first symptom is simple extraocular muscle involvement, usually ptosis, diplopia, or both, with no pupillary sphincter involvement, and bulbar or limb muscle weakness as the first feature in only about 10% of cases.

The facial expression muscles, masseter muscles, swallowing muscles, vocal cord muscles, tongue muscles, sternocleidomastoid muscles, and trapezius muscles may also be affected, and the extremity muscles are heavily affected by proximal weakness.

3. Myasthenic gravis crisis: If the patient suddenly develops severe weakness of bulbar innervation muscles and respiratory muscles, so that respiratory function cannot be maintained, it is called myasthenic gravis crisis, which can be divided into three types:

1) Myasthenic crisis: myasthenic crisis accounts for 95%, which is the result of disease development, and is more likely to occur in cases of acute infection, surgical trauma or insufficient drug dose, and significant improvement after injection of neostigmine is the characteristic of this crisis.

2) Cholinergic crisis: accounting for 4%, it is dyspnea caused by the overdose of anticholinesterase drugs, often accompanied by miosis, sweating, increased saliva secretion and other drug phenomena. Neostigmine injections are ineffective, and the symptoms are more severe.

3) Reversible crisis: 1% of the patients, during the period of taking anticholinesterase drugs, due to infection, childbirth, surgery and other factors, the patient suddenly failed to respond to anticholinesterase drugs**, and had difficulty breathing; And neostigmine injection is ineffective and does not aggravate symptoms.

There are many symptoms of myasthenia gravis, including the following aspects:

1. Ocular muscles: when the extraocular muscles are involved, there may be drooping eyelids and abnormal eye movements, such as weak eye movement to one side, patients will have double shadows when they see things, and patients with more severe muscle weakness may have eye fixation, and the eyes cannot move in all directions;

2. Facial muscle weakness: patients may have facial paralysis, patients with facial muscle weakness may have air leakage when puffing up the cheeks, salivation when speaking, the patient's eyes cannot be closed, and the white sclera may be exposed;

3. Masticatory muscle weakness: Patients with masticatory muscle weakness may not be able to complete a meal smoothly when eating, and will become more and more weak in chewing, and may also have symptoms such as difficulty swallowing and choking; 3. Limb weakness: patients with limb weakness are unable to climb stairs, or have weakness of both lower limbs after walking a relatively long distance, and some patients have difficulty and fatigue in lifting their arms after lifting their arms for a certain period of time;

4. Myasthenic crisis: The most serious symptom of myasthenia gravis is the symptom of dyspnea due to the involvement of respiratory muscles, also known as myasthenic crisis.

Patients with myasthenia gravis may only have muscle weakness in the limbs at the beginning of the disease, and in severe cases, it may affect normal life or even be life-threatening. The Amyotrophy Department of Yiling Hospital has many years of experience, and has used traditional Chinese medicine to carry out various muscular dystrophy diseases, and has achieved good results, which has greatly improved the clinical symptoms of patients and reduced their pain.

Patients with myasthenia gravis often feel soreness and discomfort in the eyes or limbs in the early stages of the disease, or blurred vision, fatigue is easily fatigued, and fatigue is aggravated by hot weather or menstrual cramps. As the disease progresses, skeletal muscles become significantly fatigued and weak, which is characterized by muscle weakness that worsens after exertion in the afternoon or evening and decreases after getting up or resting, a phenomenon called "morning light and twilight heaviness".

1. Facial muscle weakness is not easy to find. Due to the weakness of the entire facial expression muscles, the patient often can't close his eyes when sleeping, and his expression is usually indifferent, and he can't cry or laugh, which is called myopathic facial appearance in medicine. This kind of face is extremely unnatural.

Second, dysphagia is not sick in the stomach, and the appetite is very good, but good food and good food just can't swallow, some patients with myasthenia gravis can't even swallow water, and when drinking water, it either chokes into the trachea and causes coughing, or it flows out of the nostrils. There were no problems with a barium swallow contrast or gastroscopy.

3. Eyelid drooping, that is, eyelid drooping is mostly on one side in the early stage, and often on both sides in the late stage, and eyelid drooping can also occur alternately from left to right. It is characterized by light mornings and heavy afternoons.

Fourth, the general weakness from the appearance as if there is no disease, but the patient himself often feels severe general weakness, unable to lift shoulders, unable to lift hands, squatting down and unable to stand up, and some can not even wash their faces and comb their hair on their own. However, it will improve significantly after resting, and it will get significantly worse after work.

5. Double vision is the double vision of an object, one thing is seen as two, and if one eye is covered, one is seen. Very young children do not describe diplopia, and often compensate for tilting their heads and torticollis in order to make the diplopia disappear. A doctor's examination may reveal that the eye is limited in one or more directions, and in some cases, the eye is even immobile, and the size of the pupil is always normal.

Sixth, chewing is weak and the teeth are good, but the bite is weak, and even biting the steamed bun is laborious.

Myasthenia gravis is a relatively rare neurological disease, which is clinically manifested by extreme fatigue and general fatigue. At present, the cause of the disease is not clear, and it is believed that the human nerve innervates the muscles to produce movement, and if there is a disorder at the junction of the innervated muscles, the nerve motor signals cannot be transmitted smoothly. In addition, myasthenia gravis is currently speculated to be related to genetics, infection, and autoimmunity.

Thymic hyperplasia can be seen in some patients with myasthenia gravis, and if the thymus is diseased**, the muscle weakness can also be resolved homeopathically.

Muscle strength or mobility in the past is gradually weakened until the aircraft is designed to cause death.

Myasthenia gravis is an autoimmune disease that mainly violates the neuromuscular junction, and myasthenia gravis is characterized by fluctuating symptoms, i.e., mild in the morning and heavy in the evening, or fluctuating symptoms that decrease after rest and worsen after activity. Muscle weakness can involve any of the voluntary muscles, but levator palpebrae and extraocular muscles are most commonly affected, and levator palpebris and extraocular muscles are involved as ptosis, diplopia.

If the laryngeal muscles are involved, the patient will have symptoms such as hoarseness, choking on drinking water, etc., if the facial muscles are involved, the patient will have bilateral peripheral facial paralysis with a wry smile and unable to close the eyes, etc., and if the masticatory muscles are involved, it can be manifested as weakness in chewing food.

In the morning, the patient's limb muscles or eyelid muscle fatigue is relatively light, and at noon or afternoon, the patient will obviously feel that the limbs are very tired, the eyelids droop, double vision, blurred vision, etc., in the morning, the patient can easily go up and down the stairs, and in the afternoon, the patient can not go up and down the stairs in a short period of time and feel very tired. Therefore, the most obvious symptom of myasthenia gravis is a feeling of mildness in the morning and in the evening.

For patients with myasthenia gravis, there are a variety of clinical subtypes, including ophthalmic type and systemic type, etc., and the most advanced drugs used in different disease types are mainly hormones, olmistigmine, and immunosuppressants, but it is necessary to adopt an individualized ** regimen according to the patient's age, onset type, presence or absence of ** and other factors.

According to the symptoms produced by the part of the disease that affects it, it is divided into three types: ophthalmic, bulbar and generalized. Symptoms of muscle weakness are usually mild in the morning and gradually worse in the afternoon and evening, although they can also manifest in different ways.

1. Ophthalmosis gravis: that is, the lesion affects the muscles that innervate the eyes, and the mild ones show weakness in opening the eyes, drooping eyelids, limited eye movements, strabismus and diplopia, and in severe cases, the eyes are immobile.

2. Medullary (or spherical) myasthenia gravis: that is, the lesion affects the muscles of the head and face, and there may be incomplete closure of the eyes, frontal lines and nasolabial folds flattened, the posterior constriction muscle of the corner of the mouth is weaker than the levator muscle of the upper lip when laughing, and the lip lift is like a roar; weakness in chewing, difficulty swallowing, and inability to move the tongue; soft palatine muscles weak, nasal-sounding; A low or hoarse pitch after a moment of conversation.

3. Generalized myasthenia gravis: that is, the lesion involves the neck muscles, trunk and limb muscles, and it is difficult to raise the head, and the head is often supported by the hand; chest tightness and shortness of breath, weakness in walking, inability to walk for long periods of time; It is difficult to wash face, comb hair, and dress; presence of tendon reflexes without sensory deficits; Occasionally, muscle atrophy is seen.

4. Crisis refers to the sudden aggravation of muscle weakness, especially the severe weakness of respiratory muscles (including diaphragm, intercostal muscles) and throat muscles, resulting in difficulty in breathing, increased laryngeal and tracheal secretions that cannot be discharged, and the need for expectoration or artificial respiration. Can be life-threatening.