CHAPTER 5 Nervous System^241
PROGNOSIS
The disease can take a variety of forms from mild weakness and drooping of the
eye muscles to generalized, progressive weakness that ultimately affects respira-
tory function. Progression of symptoms will vary from patient to patient. There are
typically episodes of exacerbations and remissions. The more aggressive form of
the disease progresses more rapidly, resulting in death from respiratory failure.
HALLMARK SIGNS AND SYMPTOMS
- Ptosis (drooping of the eyelid) due to muscular weakness
- Diplopia (double vision) due to inability to keep both eyes focused on the
same object - Trouble closing eyes completely; dry eyes due to muscle weakness
- Difficulty swallowing (dysphagia) due to muscle weakness
- Muscle weakness later in the day due to fatigue
- Proximal muscle weakness
- Fatigue
- In advanced disease—loss of bowel and bladder control; difficulty with res-
piratory function - Myasthenic crisis is an exacerbation of symptoms due to insufficient
medication:- Tachycardia
- Tachypnea
- Elevated blood pressure
- Cyanosis
- Decrease in urinary output
- Incontinence of bowel and bladder
- Loss of gag reflex
- Cholinergic crisis is an exacerbation of weakness due to too much choliner-
gic medication:- Blurred vision
- Nausea, vomiting, diarrhea
- Abdominal cramping
- Paleness