Neurology Exam Prep Podcast Episode 76 - Neuromuscular Emergencies
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Oct 27, 2025 William Signorile, a neurology clinician moving on to a fellowship, and Jeff Dewey, a neuromuscular specialist, shed light on critical neuromuscular emergencies. They discuss the diagnostic approach to Guillain-Barré Syndrome, highlighting red flags and essential assessments. The duo contrasts Myasthenia Gravis with LEMS and covers treatments for myasthenic crisis. They also delve into the management of respiratory complications, emphasizing careful monitoring and decision-making in acute care settings.
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Draw Antibody Panels Before Immunotherapy
- Send AChR, MuSK, and LRP4 antibodies before initiating IVIG or other immune therapies to avoid false results.
- Order these labs early because treatment can alter serology.
LEMS Shows Strength After Sustained Activation
- LEMS is a presynaptic calcium-channel disorder with weakness that improves after sustained/tetanic activation.
- It often signals an underlying malignancy, classically small cell lung cancer.
Prioritize Airway And Choose IVIG Or PLEX For MG
- In myasthenic crisis provide airway support first, then treat with IVIG or plasmapheresis; PLEX may act faster in some cases.
- Avoid high-dose steroids acutely for typical AChR-positive myasthenia unless indicated (e.g., ICI-related cases).