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. 2025 Jul-Sep;5(3):100193.
doi: 10.1016/j.neurop.2025.100193. Epub 2025 Apr 2.

Myasthenic crisis probably triggered by local lidocaine infiltration unveiling generalized myasthenia gravis without extraocular muscle involvement

M León-Ruiz  1 , C Rízea  1 , J Álvarez-Troncoso  2 , M Quintana-Díaz  3   4   5 , G Zmork-Martínez  6 , J Benito-León  7   8   9   10 , J Rodríguez-Pardo  6
Affiliations

Myasthenic crisis probably triggered by local lidocaine infiltration unveiling generalized myasthenia gravis without extraocular muscle involvement

M León-Ruiz et al. Neurol Perspect. 2025 Jul-Sep.
No abstract available

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1
Figure 1
Repetitive nerve stimulation. Low-frequency repetitive nerve stimulation (RNS) at 3 Hz of the right (R) ulnar nerve recording from abductor digiti minimi revealed 20.1% (red box) decrement in amplitude from the first to the fourth compound muscle action potential (CMAP) (red arrow), corresponding to clinical muscle fatigability (A). And a maximal 43.2% (red box) decrement 2 min after exercise lasting 1 min (red arrow) (B). These results are suggestive of postsynaptic neuromuscular junction disorder.
Figure 2
Figure 2
Single-fiber electromyography (SFEMG). Volitional (voluntary) SFEMG recorded by concentric needle electrodes in the right (R) extensor digitorum (ED) (A) and frontalis (FR) (B) muscles found remarkably increased mean jitter (ED: 228 μs [upper limit 30 μs], FR: 100 μs [upper limit 28 μs], highlighted in yellow) with 100% impulse blocking in both muscles, showing a severe impairment of the postsynaptic neuromuscular junction of generalized distribution, suggestive of generalized myasthenia gravis. The jitter value was calculated by the mean consecutive difference (MCD) for each pair. We were able to study only five pairs in the R ED and four in the R FR due to the patient’s clinical and hemodynamic instability. Usually, two subtypes of SFEMG are used to diagnose MG: 1) Voluntary SFEMG measures the variability in activation time (jitter) between muscle fibres that are innervated by the same motor axon when the patient voluntary contracts the muscle, and 2) Stimulation SFEMG measures variability between the time of nerve stimulation and muscle response (jitter). Jitter for each pair of potentials can be expressed as the MCD and as the mean sorted difference (MSD). MIPI: mean interpotential interval; N: total number of observations.
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