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Myasthenia Gravis With Reversible Pyramidal Tract Damage and Pseudo Internuclear Ophthalmoplegia. A Case Report and
Yinghong Weng1,2, Yan Min2, Zhenghe Sheng2
1Department of Neurology, Guangzhou Hospital of Traditional Chinese Medicine Affiliated With Guangzhou University of Chinese Medicine, Guangzhou, China.
Abstract:
Myasthenia gravis (MG) is a rare and treatable antibody-mediated autoimmune disease. Pseudo internuclear ophthalmoplegia (-INO) or pyramidal tract damage is rarely observed in MG, and there were no known cases of MG with both pseudo-INO and pyramidal tract damage. Here, we report a case of a 61-year-old female suffering from MG accompanied by pseudo-INO and pyramidal tract damage with a rapid progressive course. Her blood and cerebrospinal fluid (CSF) tests were normal, except for the presence of the anti-acetylcholine receptor antibody. CT and contrast enhancement of the chest showed a thymic involution. MRI and contrast enhancement images of the brain and whole spine were normal. Both the clinical response to the administration of neostigmine and the repetitive nerve stimulation test were positive. The motor evoked potentials at lower limb recordings were normal. According to her signs, symptoms, decrementing response on repetitive stimulation test, elevated anti-acetylcholine receptor antibody and positive response to neostigmine, the patient was diagnosed as having MG. After treatment with pyridostigmine, intravenous immunoglobulin, prednisone acetate tablets and methotrexate, all her symptoms disappeared, including pseudo-INO and pyramidal tract damage. To our best knowledge, this is the first report of a case of MG with both pseudo-INO and pyramidal tract damage. Based on our case and a review of the literature, we propose that pyramidal tract damage and pseudo-INO can be two signs of MG, and that MG can cause damage to other systems besides neuromuscular junctions.
Insights
This study reports the first known case of myasthenia gravis (MG) presenting with both pseudo-internuclear ophthalmoplegia and pyramidal tract damage. Treatment successfully resolved these rare neurological symptoms in this antibody-mediated autoimmune disease.
Area of Science:
- Neurology
- Immunology
- Autoimmune Diseases
Background:
- Myasthenia gravis (MG) is a rare autoimmune disorder affecting neuromuscular junctions.
- Neurological complications beyond neuromuscular dysfunction are infrequently reported in MG.
- Pseudo-internuclear ophthalmoplegia (pseudo-INO) and pyramidal tract damage are exceptionally rare in MG patients.
Observation:
- A 61-year-old female presented with rapidly progressive myasthenia gravis.
- The patient exhibited both pseudo-INO and pyramidal tract damage.
- Diagnostic tests revealed anti-acetylcholine receptor antibodies, thymic involution, and positive responses to repetitive nerve stimulation and neostigmine tests.
Findings:
- This case represents the first documented instance of myasthenia gravis co-occurring with both pseudo-INO and pyramidal tract damage.
- The patient's neurological symptoms, including pseudo-INO and pyramidal tract damage, resolved completely following treatment with pyridostigmine, intravenous immunoglobulin, prednisone acetate, and methotrexate.
- Repetitive nerve stimulation and neostigmine tests confirmed the diagnosis of MG.
Implications:
- The findings suggest that pseudo-INO and pyramidal tract damage can manifest as signs of myasthenia gravis.
- This case expands the understanding of potential systemic effects of MG beyond the neuromuscular junction.
- Further research may elucidate the mechanisms linking MG to these specific neurological deficits.
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