Papilledema is found in majority of the patients with IIH while it is absent in only about 5-6% of the patients. In a neuro-ophthalmology clinic, bilateral ptosis as an initial feature of OMG must be approached cautiously because it may be the first sign of impending GMG.īackground Idiopathic intracranial hypertension (IIH) is a clinical syndrome characterized by increased intracranial pressure in the absence of clinical, laboratory, or radiological findings of space-occupying lesion in the cranium. Bilateral ptosis at onset was found as a risk factor for generalization.
In addition, an abnormal repetitive nerve stimulation test was related to a shortened time to generalization. Seropositivity for acetylcholine receptor and muscle-specific tyrosine kinase antibodies, abnormal single-fiber electromyography (SFEMG), and the presence of thymic abnormalities (thymoma and hyperplasia) were factors associated with generalization on multivariate analysis without a significant difference between the GMG-B and GMG-E groups.
GMG-B and GMG-E were diagnosed in 31 (22.3%) and 23 patients (16.5%), respectively. Of the 139 patients with OMG, 54 (39%) showed generalization with a mean time of 10.3 (range 2-24) months. Demographic, clinical, laboratory features and treatment strategies that can be associated with generalization and time to generalization were evaluated. Patients with OMG who were followed-up for at least 24 months were retrospectively analyzed. The aim of the study was to investigate the risk factors for generalization in patients with OMG admitted to a neuro-ophthalmology clinic and to determine if there were differences between patients with GMG with predominant bulbar (GMG-B) or extremity muscle (GMG-E) involvement according to the 6th and 24th-month Myasthenia Gravis Foundation of America classification ranks. Conversion to generalized myasthenia gravis (GMG) within the first 2 years has been reported in 18-85% of patients with ocular myasthenia gravis (OMG).
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