Neumann Joshua, Aqil Mohammad S, Singh Simran P, Fawaz Dema
Medical School, Oakland University William Beaumont School of Medicine, Rochester, USA.
Emergency Medicine, Corewell Health Beaumont Troy Hospital, Troy, USA.
Cureus. 2025 Aug 25;17(8):e90976. doi: 10.7759/cureus.90976. eCollection 2025 Aug.
Ocular myasthenia gravis (MG), a subtype of MG limited to the eyelids and extraocular muscles, is diagnostically challenging in the emergency department (ED). In the absence of generalized weakness, subtle symptoms such as ptosis and diplopia are more easily overlooked or misattributed to stroke or other neurologic pathologies. We present a case of a 69-year-old male whose diagnosis of ocular MG was delayed due to limited neurologic examination, underuse of simple bedside tools, and incidental imaging findings that initially suggested alternative endocrine pathology. Despite classic signs, including fatigable ptosis and diplopia, treatment with pyridostigmine was not initiated until 31 hours after ED arrival, at which point the patient experienced near-complete resolution of ocular symptoms within one hour. This case highlights the importance of maintaining clinical suspicion for MG in cranial nerve presentations. Incorporating accessible bedside tests, such as the ice pack test or acetylcholinesterase inhibitor trial, can expedite diagnosis and treatment in the ED.
眼肌型重症肌无力（MG）是MG的一种亚型，仅限于眼睑和眼外肌，在急诊科（ED）的诊断具有挑战性。在没有全身无力的情况下，上睑下垂和复视等细微症状更容易被忽视或误诊为中风或其他神经病理学疾病。我们报告一例69岁男性病例，其眼肌型MG的诊断因神经科检查有限、简单床边工具使用不足以及偶然的影像学检查结果最初提示其他内分泌疾病而延迟。尽管有典型体征，包括可疲劳性上睑下垂和复视，但直到患者到达ED后31小时才开始使用吡啶斯的明治疗，此时患者在一小时内眼部症状几乎完全缓解。该病例强调了在颅神经表现中保持对MG临床怀疑的重要性。采用可及的床边检查，如冰袋试验或乙酰胆碱酯酶抑制剂试验，可在ED中加快诊断和治疗。
