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Unilateral-external Ophthalmoplegia: ARare Presentation of Myasthenia Gravis
Muhammad Saim Khan1, Asad Habib1, Imran Basit1
1Department of Ophthalmology, Armed Forces Institute of Ophthalmology (AFIO), Military Hospital, Rawalpindi.
Abstract:
Myasthenia gravis (MG) is a disease of autoimmunity with variable and diverse clinical presentations. The target tissue is neuromuscular junction of skeletal muscles, where efficient nerve impulse transmission is hampered leading to less effective muscle contraction. Patients of MG usually present with bilateral ptosis, diplopia and fatigability, which may or may not coexist with generalised weakness, dysphagia and dysarthria. A46-year male presented with unilateral ptosis and diplopia. Except for unilateral moderate ptosis and restriction of extraocular movements, ocular and systemic examination was normal. Both ice pack and tensilon tests revealed improvement in ptosis. Patient was advised tablet pyridostigmine and prednisolone; and a remarkable improvement was noticed within a week.
Insights
Myasthenia gravis (MG), an autoimmune neuromuscular junction disorder, can present atypically. Early diagnosis and treatment with pyridostigmine and prednisolone led to rapid symptom improvement in a patient with unilateral ptosis.
Area of Science:
- Neurology
- Immunology
- Ophthalmology
Background:
- Myasthenia gravis (MG) is an autoimmune disorder affecting the neuromuscular junction, impairing nerve impulse transmission to skeletal muscles.
- Clinical presentations of MG are diverse, commonly including ptosis, diplopia, and fatigability, with potential for generalized weakness, dysphagia, and dysarthria.
Observation:
- A 46-year-old male presented with unilateral ptosis and diplopia, with otherwise normal ocular and systemic examinations.
- Diagnostic tests, including the ice pack and Tensilon tests, indicated improvement in ptosis, suggesting a neuromuscular junction disorder.
Findings:
- The patient was diagnosed with a form of myasthenia gravis, despite the atypical unilateral presentation.
- Treatment initiated with pyridostigmine and prednisolone resulted in significant clinical improvement within one week.
Implications:
- This case highlights the importance of considering myasthenia gravis even with isolated, unilateral symptoms.
- Prompt diagnosis and initiation of appropriate pharmacotherapy can lead to rapid and effective symptom management in myasthenia gravis patients.
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