Scola Rosana Herminia, Iwamoto Fábio Massaiti, Mainardi Maraya Annaai Michels, Della-Coletta Marcus Vinicius, Carvalho Gisah, Zavala Jorge Augusto, Werneck Lineu Cesar
Hospital de Clínicas, Universidade Federal do Parana, Curitiba, PR, Brasil.
Arq Neuropsiquiatr. 2003 Mar;61(1):119-20. doi: 10.1590/s0004-282x2003000100024. Epub 2003 Apr 16.
We report the case of a 30-year-old woman with a 7-year history of distal lower limbs weakness that evolved to upper limbs weakness. On neurological examination, she presented normal cranial nerves, bilateral quadriceps and feet interosseous atrophy, normal muscular tonus, muscular weakness more severe in dorsal feet interosseous and anterior tibial, and decreased deep tendon reflexes. Repetitive nerve stimulation of the ulnar and fibular nerves showed a decrement greater than 10% of the compound muscle action potential. Antibody against acetylcholine receptor titer was positive. Computed tomography scan of the thorax was normal. Thyroid function tests showed evidence of hyperthyroidism. Distal muscular weakness is a rare onset presentation of myasthenia gravis. However, myasthenia gravis must be considered in the differential diagnosis of distal limb weakness.
我们报告了一例30岁女性病例，该患者有7年的下肢远端肌无力病史，随后发展为上肢肌无力。神经系统检查显示，她的颅神经正常，双侧股四头肌和足部骨间肌萎缩，肌张力正常，足背骨间肌和胫骨前肌的肌无力更为严重，且深部腱反射减弱。尺神经和腓总神经的重复神经刺激显示复合肌肉动作电位递减超过10%。抗乙酰胆碱受体抗体滴度呈阳性。胸部计算机断层扫描正常。甲状腺功能检查显示有甲状腺功能亢进的迹象。远端肌无力是重症肌无力的一种罕见起病表现。然而，在鉴别诊断肢体远端肌无力时必须考虑重症肌无力。
