Emergency Medicine

UMEM Educational Pearls

Search

Title: Diagnosing Myasthenia Gravis in the ED

Category: Neurology

Keywords: weakness, ptosis (PubMed Search)

Posted: 1/25/2017 by Danya Khoujah, MBBS

Patients may present to the ED with new onset weakness due to myasthenia gravis (MG). A group that is frequently missed is late-onset MG, which occurs after the age of 50. It is frequently misdiagnosed as a stroke or transient ischemic attach (TIA).

Two cardinal features:

  • fatiguability: must be distinguished from fatigue. 
  • fluctuation

Bonus pearl: Ocular symptoms are present in up to 85% of patients with MG, with unilateral ptosis or asymmetric bilateral ptosis being the most common presentations.

References

Nicolle MW. Myasthenia Gravis and Lambert-Eaton Myasthenic Syndrome. Continuum. 2016;22(6):1978–2005