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.

Back to Index

Back to Example Cases

Back to Neurology