Myasthenia Gravis Presenting as Persistent Unilateral Ptosis with Facial Droop

The Journal of Emergency Medicine
Sean K GoldenMichael D Repplinger

Abstract

Myasthenia gravis (MG) is an autoimmune neuromuscular disorder that is classically characterized by fluctuating weakness and fatigability of the ocular, bulbar, limb, or respiratory muscles. Over half of patients with MG will initially experience isolated ocular symptoms in one or both eyes. Most patients report that ocular symptoms are mild or undetectable upon awakening, and worsen throughout the day or with tasks such as driving. We describe an unusual case of MG presenting with an acute onset of persistent unilateral ptosis and ipsilateral facial droop without diurnal variation or other fluctuation in severity. A 58-year-old man presented to the Emergency Department with a 3-day history of persistent, unilateral ptosis with facial droop, concerning for stroke. However, magnetic resonance imaging of the head found no evidence of stroke or any other central etiology. Routine laboratory testing was unremarkable. Neurology was consulted and they recommended sending acetylcholine receptor antibody tests. At the patient's subsequent neurology clinic visit, these tests were found to be abnormal. Electromyography was also done at this visit, confirming the diagnosis of MG. The patient subsequently underwent thymectomy and immunosup...Continue Reading

References

Dec 1, 1991·Journal of the Neurological Sciences·E BeghiG Piccolo
Aug 1, 1990·International Journal of Pediatric Otorhinolaryngology·P H Winter, C F Koopmann
Oct 1, 1989·Journal of Neurology, Neurosurgery, and Psychiatry·H J Oosterhuis
Jan 1, 1987·Annals of the New York Academy of Sciences·D GrobT Namba
Aug 1, 1986·Archives of Neurology·R B Daroff
Apr 6, 2000·The American Journal of Emergency Medicine·P B CridgeH Gerhard
Jul 9, 2002·Acta Neurologica Scandinavica·D Ratanakorn, A Vejjajiva
Jul 19, 2003·Seminars in Neurology·Robert M Pascuzzi
Jul 2, 2004·Seminars in Neurology·Matthew N Meriggioli, Donald B Sanders
Jul 26, 2005·Optometry : Journal of the American Optometric Association·Jennifer ColavitoKenneth J Ciuffreda
Jun 24, 2006·Neuromuscular Disorders : NMD·Michael Benatar
Dec 7, 2007·Muscle & Nerve·David GrobMurali Pagala
Jan 22, 2008·European Journal of Internal Medicine·J M BrostoffJ Birns
Mar 3, 2010·The Korean Journal of Internal Medicine·Won Hee KimHye Cheol Jeong
Oct 19, 2011·Autoimmune Diseases·Nils Erik GilhusJohan A Aarli

❮ Previous
Next ❯

Citations

Mar 26, 2021·Rinshō shinkeigaku = Clinical neurology·Yuka YamaguchiAkira Tsujino

❮ Previous
Next ❯

Related Concepts

Related Feeds

Ataxias (MDS)

Ataxia is a neurological condition characterized by lack of voluntary coordination of muscle movements including loss of coordination, balance, and speech. Discover the latest research on ataxia here.

Autoimmune Thyroiditis

Autoimmune thyroiditis is an inflammatory disease of thyroid gland due to autoimmune responses leading to lymphocytic infiltration of the gland. It is characterized by the presence of circulating thyroid antigen-specific T-cells and thyroid autoantibodies. Discover the latest research on autoimmune thyroiditis here.

Bradyarrhythmias

Bradyarrhythmias are slow heart rates. Symptoms may include syncope, dizziness, fatigure, shortness of breath, and chest pains. Find the latest research on bradyarrhythmias here.

Ataxia

Ataxia is a neurological condition characterized by lack of voluntary coordination of muscle movements including loss of coordination, balance, and speech. Discover the latest research on ataxia here.

Ataxias

Ataxia is a neurological condition characterized by lack of voluntary coordination of muscle movements including loss of coordination, balance, and speech. Discover the latest research on different types of ataxias here.

Arrhythmia

Arrhythmias are abnormalities in heart rhythms, which can be either too fast or too slow. They can result from abnormalities of the initiation of an impulse or impulse conduction or a combination of both. Here is the latest research on arrhythmias.

Autoimmune Diseases

Autoimmune diseases occur as a result of an attack by the immune system on the body’s own tissues resulting in damage and dysfunction. There are different types of autoimmune diseases, in which there is a complex and unknown interaction between genetics and the environment. Discover the latest research on autoimmune diseases here.

Atrial Fibrillation

Atrial fibrillation is a common arrhythmia that is associated with substantial morbidity and mortality, particularly due to stroke and thromboembolism. Here is the latest research.