Factors of stroke misdiagnosis at the onset of myastenia gravis
- Authors: Alibekov A.R.1,2, Goldobin V.V.1, Yuldashev H.F.1, Klocheva E.G.1, Lubenets I.A.1, Nurmakhanbetova A.Z.1
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Affiliations:
- North-Western State Medical University named after I.I. Mechnikov
- Vsevolozhsk Clinical Interdistrict Hospital
- Issue: Vol 15, No 4 (2023)
- Pages: 41-50
- Section: Original research
- Submitted: 14.06.2023
- Accepted: 12.07.2023
- Published: 13.01.2024
- URL: https://journals.eco-vector.com/vszgmu/article/view/492276
- DOI: https://doi.org/10.17816/mechnikov492276
- ID: 492276
Cite item
Abstract
BACKGROUND: Myasthenia gravis is a rare autoimmune disease,which is difficult to diagnose mainly in the initial stages, when there are single symptoms of the disease or an atypical course. Diagnostic errors are associated with the fact that myasthenia gravis and other diseases of the nervous system have similar symptoms. The most common misdiagnosis in the onset of myasthenia gravis is a stroke. However, the reasons for a false diagnosis remain unspecified and poorly understood.
AIM: To determine the factors leading to misdiagnosis of a stroke in the onset of myasthenia gravis.
MATERIALS AND METHODS: 133 patients diagnosed with myasthenia gravis were divided into two groups. Patients with misdiagnosed stroke at the onset of myasthenia gravis formed the first group, the rest of the patients – the second group. A comparative assessment was performed according to the age of myasthenia onset, the clinical variant of the onset, primary symptoms, the duration of diagnosis, and the severity of the disease at the time of the correct diagnosis, with the percentage of misdiagnosis calculation.
RESULTS: Stroke as misdiagnosis was established more often than others (in 23% of all cases and in 44% of incorrect diagnoses). In the 1st group, complaints of dysarthria and dysphagia were significantly higher, myasthenia gravis began acutely more often, the age of myasthenia onset in patients of the 1st group was statistically higher than in the 2nd. There was no difference between the groups in terms of diagnosis duration, the disease severity, and the history of previous stroke.
CONCLUSIONS: Factors leading to stroke misdiagnosis at the onset of myasthenia are advanced age and acute onset with bulbar disorders.
Keywords
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About the authors
Ailer R. Alibekov
North-Western State Medical University named after I.I. Mechnikov; Vsevolozhsk Clinical Interdistrict Hospital
Email: alibekov.ailer@gmail.com
ORCID iD: 0000-0001-5308-6985
SPIN-code: 1112-9540
MD, postgraduate student
Russian Federation, 47 Piskarevsky Ave., Saint Petersburg, 195067; Vsevolozhsk, Leningrad regionVitaliy V. Goldobin
North-Western State Medical University named after I.I. Mechnikov
Email: vitalii.goldobin@szgmu.ru
ORCID iD: 0000-0001-9245-8067
SPIN-code: 4344-5782
MD, Dr. Sci. (Med.), Professor
Russian Federation, 47 Piskarevsky Ave., Saint Petersburg, 195067Hosiddin F. Yuldashev
North-Western State Medical University named after I.I. Mechnikov
Email: kh.yuldashev96@gmail.com
ORCID iD: 0000-0003-3781-5871
MD, postgraduate student
Russian Federation, 47 Piskarevsky Ave., Saint Petersburg, 195067Elena G. Klocheva
North-Western State Medical University named after I.I. Mechnikov
Email: elena.klocheva@szgmu.ru
ORCID iD: 0000-0001-6814-0454
SPIN-code: 6220-5349
MD, Dr. Sci. (Med.), Professor
Russian Federation, 195067, Санкт-Петербург, Пискаревский пр., д. 47Irina A. Lubenets
North-Western State Medical University named after I.I. Mechnikov
Email: IrkaLu2000@yandex.ru
5th year student of the medical faculty
Russian Federation, 47 Piskarevsky Ave., Saint Petersburg, 195067Aruzhan Zh. Nurmakhanbetova
North-Western State Medical University named after I.I. Mechnikov
Author for correspondence.
Email: pretty_19_99@mail.ru
6th year student of the medical faculty
Russian Federation, 47 Piskarevsky Ave., Saint Petersburg, 195067References
- Gusev EI, Gekht AB. Klinicheskie rekomendatsii po diagnostike i lecheniyu miastenii. Moscow: Vserossiiskoe obshchestvo nevrologov; 2013. 29 p. (In Russ.)
- Breiner A, Widdifield J, Katzberg HD, et al. Epidemiology of myasthenia gravis in Ontario, Canada. Neuromuscul Disord. 2016;26:41–46. doi: 10.1016/j.nmd.2015.10.009
- Maddison P, Ambrose PA, Sadalage G, Vincent A. a prospective study of the incidence of myasthenia gravis in the East Midlands of England. Neuroepidemiology. 2019;53:93–99. doi: 10.1159/000500268
- Martinka I, Fulova M, Spalekova M, Spalek P. Epidemiology of myasthenia gravis in Slovakia in the years 1977–2015. Neuroepidemiology. 2018;50:153–159. doi: 10.1159/000487886
- Alekseeva TM, Kryuchkova VV, Stuchevskaya TR, Khalmurzina AN. Epidemiologic studies of myasthenia gravis: literature review. Neuromuscular Diseases. 2018;8(3):12–18. (In Russ.). doi: 10.17650/2222-8721-2018-8-3-12-18
- Park S-Y, Lee JY, Lim NG, Hong Y-H. Incidence and prevalence of myasthenia gravis in Korea: a population-based study using the national health insurance claims database. J Clin Neurol. 2016;12:340. doi: 10.3988/jcn.2016.12.3.340
- Sanders DB, Raja SM, Guptill JT, et al. The duke myasthenia gravis clinic registry: I. description and demographics. Muscle Nerve. 2021;63:209–216. doi: 10.1002/mus.27120
- Zieda A, Ravina K, Glazere I, et al. A nationwide epidemiological study of myasthenia gravis in Latvia. Eur J Neurol. 2018;25:519–526. doi: 10.1111/ene.13535
- Aarli JA. Myasthenia gravis in the elderly. Is it different? Ann NY Acad Sci. 2008;1132:238–243. doi: 10.1196/annals.1405.040
- Romanova TV. Ways to optimize diagnostic and therapeutic care for patients with myasthenia gravis (analysis of the experience of the regional myasthenic center). Practical medicine. 2012;(2(57)):153–157. (In Russ.)
- Rodolico C, Parisi D, Portaro S, et al. Myasthenia gravis: unusual presentations and diagnostic pitfalls. J Neuromuscul Dis. 2016;3:413–418. doi: 10.3233/JND-160148
- Vincent A. Evidence of underdiagnosis of myasthenia gravis in older people. J Neurol Neurosurg Psychiatry. 2003;74:1105–1108. doi: 10.1136/jnnp.74.8.1105
- Lobzin SV, Alibekov AR, Klocheva EG, et al. Diffculties in differential diagnosis of myasthenia gravis (clinical case). Medical alphabet. 2022;1(32):13–16. (In Russ.) doi: 10.33667/2078-5631-2022-32-13-16
- Khalmurzina AN., Alekseeva TM., Lobzin SV. et al. Analysis of clinical manifestations and diagnosis of late-onset myasthenia gravis. Neuromuscular Diseases. 2020;10(1):53–63. (In Russ.) doi: 10.17650/2222-8721-2020-10-1-53-63
- Basiri K, Ansari B, Okhovat A. Life-threatening misdiagnosis of bulbar onset myasthenia gravis as a motor neuron disease: how much can one rely on exaggerated deep tendon reflexes. Adv Biomed Res. 2015;4:58. doi: 10.4103/2277-9175.151874
- Lavrnić D, Rakocević-Stojanović V, Tripković I, et al. Diagnostic problems in patients with myasthenia gravis. Srp Arh Celok Lek. 2000;128:247–252. (In Serbian)
- Al-Asmi A, Nandhagopal R, Jacob PC, Gujjar A. Misdiagnosis of myasthenia gravis and subsequent clinical implication: a case report and review of literature. Sultan Qaboos Univ Med J. 2012;12:103–108. doi: 10.12816/0003095
- Durand F, Camdessanché J-P, Jomir L, et al. Myasthenia in elderly patients: a series of 23 cases. Rev Méd Interne. 2005;26:924–930. (In French). doi: 10.1016/j.revmed.2005.08.009
- Fisman GK, Kott HS. Myasthenia gravis mimicking stroke in elderly patients. Mayo Clin Proc. 1998;73:1077–1078. doi: 10.4065/73.11.1077
- Libman R, Benson R, Einberg K. Myasthenia mimicking vertebrobasilar stroke. J Neurol. 2002;249:1512–1514. doi: 10.1007/s00415-002-0858-2
- Tremolizzo L, Giopato F, Piatti ML, et al. Myasthenia gravis mimicking stroke: a case series with sudden onset dysarthria. Neurol Sci. 2015;36:895–898. doi: 10.1007/s10072-015-2098-0
- Miasteniya: diagnostika i lechenie. Ed. by S.V. Lobzin. Saint Petersburg: SpetsLit; 2015. 160 p. (In Russ.)
- Menon SR, Mokkath NR. Myasthenia gravis masquerading as acute stroke: a case report. Pan Afr Med J. 2020;37:305. doi: 10.11604/pamj.2020.37.305.27032
- Montero-Odasso M. Dysphonia as first symptom of late-onset myasthenia gravis. J Gen Intern Med. 2006;21:C4–6. doi: 10.1111/j.1525-1497.2006.00343.x
- Shaik S, Ul-Haq MA, Emsley HC. Myasthenia gravis as a ‘stroke mimic’ – it’s all in the history. Clin Med. 2014;14:640–642. doi: 10.7861/clinmedicine.14-6-640
- Serdyuk AV, Kovrazhkina EA, Vyatkina NV. A case of severe generalized myasthenia with late onset and predominant lesion of bulbar muscles: the case report and review. Consilium medicum. 2018;20(2):59–62. (In Russ.) doi: 10.26442/2075-1753_2018.2.59-62
- Digala L, Bailey E, Govindarajan R. Myasthenia gravis mimicking acute cerebrovascular events. RRNMF Neuromuscul J. 2020;1:9–12. doi: 10.17161/rrnmf.v1i3.13573