RT Journal Article
SR Electronic
T1 Myasthenia gravis as a ‘stroke mimic’ – it's all in the history
JF Clinical Medicine
JO Clin Med
FD Royal College of Physicians
SP 640
OP 642
DO 10.7861/clinmedicine.14-6-640
VO 14
IS 6
A1 Saiffuddin Shaik
A1 Mian Ayaz Ul-Haq
A1 Hedley CA Emsley
YR 2014
UL http://www.rcpjournals.org/content/14/6/640.abstract
AB An 85-year-old man presented to hospital as an emergency having difficulties with swallowing and speech. In the emergency department, he was assessed as having acute onset dysphagia and dysarthria in keeping with an acute stroke. Subsequently, it became apparent that although the symptoms were indeed of relatively acute onset, there was a clear description by the patient of fatigability and diurnal variation, prompting a working clinical diagnosis of myasthenia gravis. The patient followed a turbulent clinical course, and interpretation of investigation results proved not to be straightforward in the acute setting. Myasthenia gravis is an uncommon disorder but it is more common in the elderly. This case provides key learning points, particularly highlighting the value of prompt, accurate clinical assessment and the importance of adhering to the clinical diagnostic formulation.