Myasthenia gravis - problems in diagnosis. A case presentation

Abstract

The possibility of myasthenia gravis must be considered in patients persistently complaining of weakness and fatigue. There may be many difficulties and pitfalls in differentiating myasthenia gravis from other disorders in which muscular weakness is a common complaint. Myasthenia gravis is an autoimmune disease caused by a defect of neuromuscular transmission due to antibodymediated attack. Dysphagia and dysarthria are two of the common symptoms and are due to oropharyngeal muscles involvement. They can be the first symptoms of the disease and sometimes can be mistaken for manifestations of emotional problems, usually anxiety or depression. The disease may be underappreciated as a cause of bulbar weakness. If clinical findings and history are highly suggestive, complementary tests should be performed (and sometimes maybe repeated) in order to confirm the diagnosis before psychasthenia or another psychiatric diagnosis is considered. We report the case of a 42-year-old woman who was admitted in our clinic for swallowing difficulties leading at the end of the day to total dysphagia, dysarthria, fluctuating limb muscle weakness and bilateral eyelids ptosis with incomplete occlusion.

Keywords

• myasthenia gravis
• differential diagnosis
• dysphagia
• dysarthria