Chijoke A, Ogunmodele J A
Department of Medicine, University of Ilorin Teaching Hospital, Ilorin.
West Afr J Med. 2009 Nov-Dec;28(6):391-3.
Myasthenia gravis (MG) is generally a rare disorder and may thus be easily misdiagnosed. Misdiagnosis is even more likely when the presentation is atypical.
To present and discuss an unusual presentation of myasthenia gravis
A 67-year-old man presented with progressive weakness of three months duration. Full clinical and limited laboratory evaluations were carried out and therapeutic treatment embarked upon.
Illness started with generalized weakness and inability to maintain a conversation. Illness become so severe that he could not get up from sitting position This was accompanied by development of double vision. On examination he looked generally healthy except for bilateral ptosis and presence of diplopia. The was a prompt response to an injection of neostigmine methylsulphate. Haematological, biochemical and hormonal studies yielded essentially normal results. A clinical diagnosis of myasthenia gravis was made. Patient was placed on pyridostigmine and prednisolone to which he responded very satisfactory.
Typically myasthenia gravis presents with ptosis but clinicians should be aware that that is not invariable and that it may start with limb weakness.
重症肌无力（MG）通常是一种罕见疾病，因此可能容易被误诊。当临床表现不典型时，误诊的可能性更大。
介绍并讨论一例不寻常的重症肌无力表现。
一名67岁男性出现进行性肌无力，病程3个月。进行了全面的临床检查和有限的实验室评估，并开始进行治疗。
疾病始于全身无力，无法进行对话。病情变得非常严重，以至于他无法从坐姿起身，同时伴有复视。检查时，除双侧上睑下垂和复视外，他总体看起来健康。注射甲基硫酸新斯的明后有迅速反应。血液学、生化和激素检查结果基本正常。做出了重症肌无力的临床诊断。患者接受了吡啶斯的明和泼尼松龙治疗，反应非常令人满意。
典型的重症肌无力表现为上睑下垂，但临床医生应意识到情况并非总是如此，该病可能始于肢体无力。
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