Ice Pack Test Diagnoses Patient Undergoing Myasthenic Crisis, Case Study Reports

Ice Pack Test Diagnoses Patient Undergoing Myasthenic Crisis, Case Study Reports

A patient with symptoms of a myasthenic crisis was successfully diagnosed with myasthenia gravis (MG), using an approach called the ice pack test, a case study reports.

The study, “Ice Pack Test – An Useful Bedside Test to Diagnose Myasthenia Gravis,” was published in QJM: An International Journal of Medicine.

MG is an autoimmune disorder that affects the muscles’ ability to contract, leading to muscle weakness and extreme fatigue. During its earlier stages, MG tends to affect the muscles that control the movements of the eyes and eyelids, causing partial eye paralysis and drooping of the upper eyelids, a condition called ptosis.

However, in cases of generalized MG, patients might start to lose respiratory muscle control and have difficulty speaking, as well as problems with chewing and swallowing. They may also experience shortness of breath, or dyspnea, and shallow breathing.

This can lead to a myasthenic crisis, a serious medical complication that usually requires hospitalization and respiratory support.

In this study, clinicians described a 35-year-old patient who was admitted to the emergency room with acute respiratory failure. During the first day, his shortness of breath worsened, and he lost consciousness. He was then sedated and put on respiratory support.

Two days later, he was taken off sedation and regained consciousness. At this point, clinicians noted drooping of both of his upper eyelids. A review of his medical history revealed he had been struggling for the past month with generalized muscle weakness, double-vision, called diplopia, and difficulty swallowing, or dysphagia.

The doctors suspected MG. To help confirm this, they performed the ice pack test, which consists of placing a bag filled with ice over the patients’ eyelids for two to five minutes, then checking for signs of droopy eyelid improvement. This test is conducted on the basis that cold improves MG symptoms, while heat worsens them.

The test was positive. The patient was immediately treated with intravenous immunoglobulins and a high dose of steroids to bring his myasthenic crisis under control. Further tests confirmed the diagnosis of MG.

After treatment, the patient improved considerably, and he was removed from respiratory support. He was eventually discharged from the hospital.

“Diagnosing a myasthenic crisis is especially challenging in an intubated patient,” the researchers noted. However, the “ice pack test is a very useful bedside test when myasthenia gravis is suspected as it’s safe, cheap and easily performed.”

Joana is currently completing her PhD in Biomedicine and Clinical Research at Universidade de Lisboa. She also holds a BSc in Biology and an MSc in Evolutionary and Developmental Biology from Universidade de Lisboa. Her work has been focused on the impact of non-canonical Wnt signaling in the collective behavior of endothelial cells — cells that make up the lining of blood vessels — found in the umbilical cord of newborns.
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Joana is currently completing her PhD in Biomedicine and Clinical Research at Universidade de Lisboa. She also holds a BSc in Biology and an MSc in Evolutionary and Developmental Biology from Universidade de Lisboa. Her work has been focused on the impact of non-canonical Wnt signaling in the collective behavior of endothelial cells — cells that make up the lining of blood vessels — found in the umbilical cord of newborns.
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