Empirical pyridostigmine in a patient with difficult weaning from mechanical ventilation after traumatic brain injury
  • Tariq Siddiqui
    Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
  • Gustav Strandvik
    Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar; Department of Surgery, Weill Cornell Medical College, Doha, Qatar
  • Ayman El-Menyar
    Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar; Department of Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
  • Sandro Rizoli
    Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
  • Hassan Al-Thani
    Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar

Keywords

Traumatic brain injury, myasthenia gravis, empirical pyridostigmine, mechanical ventilation

Abstract

We present a 30-year-old male who sustained a mild traumatic brain injury and then was intubated due to deterioration of consciousness. A head CT scan revealed mild brain oedema, a fractured nasal bone and mild left thoracic wall haematoma. Despite complete clinical and radiological normalisation within 36 hours, he failed to wean off the ventilator. The patient was found to have subtle bulbar manifestations including dysphonia, dysarthria, and dysphagia, with recurrent left lung collapse. He responded to an empirical pyridostigmine trial despite negative biochemical tests for myasthenia gravis (MG). The patient was weaned successfully from the ventilator, transferred to a long-term care facility, and then discharged home. Classic symptoms and signs of a disease may be absent, but the presence of dysarthria, dysphagia, transient vocal cord palsy, nasal speech, absent gag reflex and respiratory failure in difficult-to-wean patients, with no definitive diagnosis, may warrant an empirical trial of therapy for suspected MG and for the benefit of any doubt.

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    Published: 2024-03-25
    Issue: 2024: Vol 11 No 4 (view)

    How to cite:
    1.
    Siddiqui T, Strandvik G, El-Menyar A, Rizoli S, Al-Thani H. Empirical pyridostigmine in a patient with difficult weaning from mechanical ventilation after traumatic brain injury. EJCRIM 2024;11 doi:10.12890/2024_004363.