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Reminder of important clinical lesson
CASE REPORT
Ischaemic stroke in a patient with myasthaenic crisis and antiphospholipid antibody syndrome
  1. Jose Danilo B Diestro1,
  2. Maria Kristina C Dorotan2,
  3. Vida Margarette D Andal1,
  4. Arnolfo B Tomas3,
  5. Romergryko G Geocadin4 and
  6. Ma Epifania V Collantes1
  1. 1 Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
  2. 2 Department of Neurology, Lewis Katz School ofMedicine, Temple University, Philadelphia, Pennsylvania, USA
  3. 3 Department of Medicine, College of Medicine and Philippines General Hospital, University of the Philippines Manila, Manila, Philippines
  4. 4 Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  1. Correspondence to Dr Jose Danilo B Diestro, danni.diestro{at}gmail.com

Abstract

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.

  • stroke
  • neuromuscular disease
  • immunology
  • neurology

https://doi.org/10.1136/bcr-2019-231239

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    Footnotes

    • Contributors JDBD, MKCD, ABT, VMDA, RGG and MEVC were responsible for conception, design and acquisition of data. JDBD, MKCD, ABT, VMDA, RGG and MEVC were responsible for drafting the article and revising it for critically important content. JDBD, MKCD, VMDA, ABT, RGG and MEVC had final approval of the final manuscript. JDBD, MKCD, VMDA, ABT, RGG and MEVC have agreed to be accountable for the article and to ensure that all questions regarding the accuracy or integrity of the article are investigated.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Obtained.