Gracey Celeste, Balladares Ricardo
Internal Medicine, Campbell University School of Osteopathic Medicine, Lillington, USA.
Internal Medicine, WakeMed, Raleigh, USA.
Cureus. 2023 Sep 5;15(9):e44737. doi: 10.7759/cureus.44737. eCollection 2023 Sep.
Myasthenia gravis (MG) is a neuromuscular junction disorder involving autoantibodies affecting the postsynaptic muscle membrane. We report an 81-year-old man who presented to the emergency department with three days of left facial droop, who later developed worsening bilateral ptosis, cervical weakness, dysphagia, and dysarthria following an assessment for Bell's palsy. Ultimately, he was diagnosed with MG. This patient's presentation was atypical and challenging. Specifically, the patient had droopy eyelids from a redundancy of skin and an anatomical neck droop, non-specific findings in older adults, which obscured the development of bilateral ptosis and cervical weakness, a classic sign of bulbar disease. The patient also presented with unilateral facial weakness, a rare finding in MG and concerning stroke in the elderly population. Our aim is to discuss the challenges of identifying MG in older populations and to discuss pharmacological challenges in assessing elderly patients with suspected bulbar palsies.
重症肌无力（MG）是一种神经肌肉接头疾病，涉及影响突触后肌膜的自身抗体。我们报告一名81岁男性，因左侧面部下垂3天就诊于急诊科，在接受贝尔麻痹评估后，随后出现双侧上睑下垂加重、颈部无力、吞咽困难和构音障碍。最终，他被诊断为重症肌无力。该患者的表现不典型且具有挑战性。具体而言，患者因皮肤冗余和解剖学上的颈部下垂导致眼睑下垂，这在老年人中是非特异性表现，掩盖了双侧上睑下垂和颈部无力的发展，而这是球部疾病的典型体征。该患者还出现了单侧面部无力，这在重症肌无力中是罕见表现，在老年人群中需警惕中风。我们的目的是讨论在老年人群中识别重症肌无力的挑战，并讨论评估疑似球部麻痹老年患者时的药理学挑战。
