Royal Australasian College of Physicians Examinations/Resources/Clinical Exam/Short Cases/Example Cases/Myaesthenia Gravis

      Myaesthenia Gravis

      Stem: Please examine this person's eyes.

      Key Features

      • Ptosis – may be asymmetrical. Worse after sustained upward gaze
      • Diplopia (+/- ophthalmoplegia) with sustained upward gaze
      • Bulbar weakness -> dysarthria (counting back from 20 to 1)
      • Neck extensor weakness

      Proceed to

      • Proximal arm weakness with fatiguability
      • Look for thymectomy scar
      • Ask for spirometry / RFTs


      Presentation

      This patient has clinical features of myaesthenia gravis; evidenced by bilateral ptosis and diplopia on upward gaze; weakness of neck extension and fatiguability of shoulder abductors with a median sternotomy scar that suggests a previous thymectomy.

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      Last modified on 20 July 2009, at 17:49