bluestar
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A 67-year-old man comes to the physician because of a 6-month history of double vision, slurred speech, and difficulty swallowing liquids. Initially, his symptoms were intermittent but now occur daily and are worse at the end of the day. Over the past week, he has had shortness of breath with exertion. He has pernicious anemia treated with monthly vitamin B12 (cyanocobalamin) injections and autoimmune thyroid disease currently treated with thyroid replacement therapy. Examination shows bilateral ptosis and disconjugate gaze. There is bilateral facial weakness and hypernasal speech. The tongue is weak, and the gag reflex is reduced. Muscle strength is 4/5 in the proximal muscles of the upper and lower extremities. Deep tendon reflexes are 2+ diffusely. Babinski's sign is absent. Sensory examination shows no abnormalities. A CT scan of the chest is shown. Which of the following is the most likely diagnosis of this patient's intrathoracic lesion? A ) Aspiration pneumonia B ) Bronchogenic carcinoma C ) Lung metastasis D ) Sarcoidosis E ) Thymoma F ) Thyroid carcinoma
Sorry can't show the CT. but try to use the above info.
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| nisha
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E)? I am thinkin myasthenia gravis (sympt worse at end of day)
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| tamar
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E.
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| chemamr
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E?
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| bobby
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true, E is correct
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| mani
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E ) Thymoma
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| bluestar
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Can it be Eaten-lambert syn in Lung Canver? actually, in the CT image, there seems a thing in the hilar region.
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| nisha
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no, eaton lambert would get better as the day went on
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| bluestar
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Nisha,could you tell me what are the other difference b/t Eaton-Lambert and myasthenia gravis?I need to refresh my memory now. 
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| mani
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Eaton lambert:
1. Defect in presynaptic Ca Channels affecting neurotransmitter release
2. muscular weakness, improves with activity
3. association with malignancies (occurs as a paraneoplastic synd)
myesthenia gravis:
1. defect in postsynaptic acetylcholine receptors (antibody mediated destruction)
2. muscular weakness, worsons with activity
3. association woth thymoma
any additions will be more than welcome
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| nisha
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on EMG: diminished amplitude of compound muscle action potential to repetitive stimulation (3-5 Hz) with myasthenia gravis but, in eaton lambert, repetitive nerve stimulation (>10Hz) causes increment in amplitude
Symptoms of eaton lambert will not improve upon edrophonium administration
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| bluestar
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Solely based on clinical presentation, the two disease can be differentiated. myasthesia always involves ocular muscle while eaton lambert involves proximal muscle. and the key word in the question stem that makes us chose myasthesia is "worse at the end of the day"
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