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Myasthenia gravis as a 'stroke mimic'--it's all in the history
Saiffuddin Shaik1, Mian Ayaz Ul-Haq1, Hedley C A Emsley2
1Department of Neurology, Royal Preston Hospital, Preston, UK;
Abstract:
An 85-year-old man presented to hospital as an emergency having difficulties with swallowing and speech. In the emergency department, he was assessed as having acute onset dysphagia and dysarthria in keeping with an acute stroke. Subsequently, it became apparent that although the symptoms were indeed of relatively acute onset, there was a clear description by the patient of fatigability and diurnal variation, prompting a working clinical diagnosis of myasthenia gravis. The patient followed a turbulent clinical course, and interpretation of investigation results proved not to be straightforward in the acute setting. Myasthenia gravis is an uncommon disorder but it is more common in the elderly. This case provides key learning points, particularly highlighting the value of prompt, accurate clinical assessment and the importance of adhering to the clinical diagnostic formulation.
Insights
This case highlights a diagnostic challenge in an elderly patient presenting with acute swallowing and speech difficulties. Prompt clinical assessment is crucial for accurately diagnosing myasthenia gravis, especially in older adults.
Area of Science:
- Neurology
- Geriatrics
Background:
- Myasthenia gravis is a rare neuromuscular disorder, more prevalent in the elderly.
- Distinguishing myasthenia gravis from stroke can be challenging due to overlapping symptoms like dysphagia and dysarthria.
Observation:
- An 85-year-old male presented with acute onset dysphagia and dysarthria, initially suspected as stroke.
- Patient's reported fatigability and diurnal symptom variation suggested myasthenia gravis.
Findings:
- The case underscores the complexity of diagnosing myasthenia gravis in the acute setting, particularly in elderly patients.
- Diagnostic interpretation was complicated by the patient's turbulent clinical course.
Implications:
- Accurate and timely clinical assessment is vital for correct diagnosis and management of neuromuscular disorders.
- Adherence to established clinical diagnostic formulations aids in managing complex neurological presentations in older adults.
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