Clinical Reasoning: Myokymia, Dysautonomia, and Uveitis Researching a Common Denominator

Clinical Reasoning: Myokymia, Dysautonomia, and Uveitis Researching a Common Denominator

Mikhail M¹, Maurice C^2*

¹Faculty of Medicine, University of Toronto, Toronto, Canada

²Pencer Brain Tumor Centre, Princess Margaret Hospital Cancer Centre, Toronto, Canada

Corresponding Author: Catherine Maurice, MD, FRCPC

Address: Neuro-Oncologist, Princess Margaret Cancer Centre, 610 University Avenue, Office: 18-717, Toronto, ON, Canada, M5G 2M9; Office Phone: 416-946-2277; Office Fax: 416-946-2284; Email: Catherine.Maurice@uhn.ca

Received date: 29 November 2019; Accepted date: 19 December 2019; Published date: 2 January 2020

Citation: Mikhail M, Maurice C. Clinical Reasoning: Myokymia, Dysautonomia, and Uveitis Researching a Common Denominator. Asp Biomed Clin Case Rep. 2020 Jan 2;3(1):22-24.

Copyright © 2020 Mikhail M, Maurice C. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium provided the original work is properly cited.

Keywords: Morvan’s Syndrome; Caspr2 Antibody; Paraneoplastic Syndrome; Limbic Encephalitis; Dysautonomia; Uveitis; Neuromyotonia; Mycophenolate Mofetil

Abbreviations: EMG: Electromyography; Caspr2: Contactin Associated Protein-Like 2; CT: Computed Tomography; PET: Positron Emission Tomography

Section-1

A 56-year old man, originally from Pakistan, presented with bilateral avascular necrosis of the hips on a background of emphysema, pulmonary fibrosis, coronary artery disease, diabetes type 2 and psoriasis. The cause of the avascular necrosis was unclear, with no recent trauma or steroid use. During his preoperative consultation, he presented dysautonomia requiring an inpatient investigation; the surgery was canceled. He reported a thirty-pound weight loss and a three-week history of night sweats and shortness of breath. While hospitalized, this gentleman presented subacute confusion and fluctuation of his sensorium, compatible with limbic encephalitis. Furthermore, he developed diffuse myokymia involving the axial and appendicular musculature, confirmed by EMG.