Neurology

Myasthenia gravis crisis symptoms: increased generalized and oropharyngeal weakness, respiratory insufficiency worse in supine. Treatment: measurement of vital capacity q2h in ICU; wean off ventilator if maximal inspiratory pressure (MIP), also known as negative inspiratory force, stronger than -30 cmH2O; withdrawal of anticholinesterase inhibitors to rule out cholinergic crisis; plasmapheresis or IVIG (still takes days to work), plus high dose steroids.