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Excessive daytime sleepiness in a patient with coexisting myotonic dystrophy type 1, myasthenia gravis and Graves’ disease
Affiliations- Department of Neurology, Medical University of Bialystok, Bialystok, Poland
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Erlangen and Friedrich-August-Universität Erlangen-Nürnberg, Erlangen, Germany
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Abstract
A 41-year-old female with history of Graves’ disease, bilateral cataract, paroxysmal atrial fibrillation was admitted because of muscle weakness, daytime sleepiness, fatigability, drowsiness, bilateral eyelid ptosis, descending of head and lower jaw. On neurological examination the patient was presented with muscle weakness, muscle atrophy (in face and sternocleidomastoid muscles), features of myotonia and apocamnosis (orbicular muscles). Electromyography revealed myopathic changes, myotonic and pseudomyotonic discharges, positive repetitive nerve stimulation test in proximal muscles. Myotonic dystrophy (MD) diagnosis was confirmed by genetic testing and myasthenia gravis (MG) by a positive titer of cholinergic receptor autoantibodies. In the CSF concentration of hypocretin was significantly decreased.
Abstract
A 41-year-old female with history of Graves’ disease, bilateral cataract, paroxysmal atrial fibrillation was admitted because of muscle weakness, daytime sleepiness, fatigability, drowsiness, bilateral eyelid ptosis, descending of head and lower jaw. On neurological examination the patient was presented with muscle weakness, muscle atrophy (in face and sternocleidomastoid muscles), features of myotonia and apocamnosis (orbicular muscles). Electromyography revealed myopathic changes, myotonic and pseudomyotonic discharges, positive repetitive nerve stimulation test in proximal muscles. Myotonic dystrophy (MD) diagnosis was confirmed by genetic testing and myasthenia gravis (MG) by a positive titer of cholinergic receptor autoantibodies. In the CSF concentration of hypocretin was significantly decreased.
Keywords
Myotonic dystrophy, Myasthenia gravis, Graves’ disease, Hypocretin
About this articleTitle
Excessive daytime sleepiness in a patient with coexisting myotonic dystrophy type 1, myasthenia gravis and Graves’ disease
Journal
Neurologia i Neurochirurgia Polska
Issue
Pages
190-193
Page views
274
Article views/downloads
373
DOI
10.1016/j.pjnns.2017.01.007
Bibliographic record
Neurol Neurochir Pol 2017;51(2):190-193.
Keywords
Myotonic dystrophy
Myasthenia gravis
Graves’ disease
Hypocretin
Authors
Katarzyna Kapica-Topczewska
Robert Pogorzelski
Joanna Tarasiuk
Wiesław Drozdowski
Piotr Lewczuk
Alina Kułakowska
