Open AccessIschaemic stroke in a patient with myasthaenic crisis and antiphospholipid antibody syndrome
Author(s) -
Jose Danilo Bengzon Diestro,
Maria Kristina Dorotan,
Vida Margarette de Vera Andal,
Arnolfo B. Tomas,
Romergryko G. Geocadin,
Ma. Epifania V. Collantes
Publication year - 2019
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr-2019-231239
Subject(s) - medicine , ischaemic stroke , stroke (engine) , cyclophosphamide , etiology , neurointensive care , recombinant tissue plasminogen activator , thrombolysis , intensive care unit , antiphospholipid syndrome , tissue plasminogen activator , thrombosis , pediatrics , intensive care medicine , ischemic stroke , modified rankin scale , chemotherapy , ischemia , mechanical engineering , myocardial infarction , engineering
While autoimmune diseases have been frequently found to coexist in the same patients, the co-occurrence of myasthaeniagravis and antiphospholipid antibody syndrome (APAS) has only been reported in eight cases. We present a case of a 46-year-old Filipina who developed ischaemic stroke while admitted at the neurocritical unit for myasthaenic crisis. She was successfully thrombolysed with intravenous recombinant tissue plasminogen activator (rTPA), given a regimen of intravenous Ig and a dose of cyclophosphamide prior to discharge. Extensive workup revealed APAS to be the aetiology of her stroke. Twenty-one months into her follow-up, she is doing well with a modified Rankin Score of 0. Our case suggests that rTPA followed by immunomodulators may be given safely in myasthaenic crisis patients who develop ischaemic stroke. We emphasise the importance of doing a comprehensive neurological evaluation in agitated patients in the critical care unit.