The Rational Clinical Examination
David L. Simel, Drummond Rennie
Myasthenia Gravis
Katalin Scherer, Richard S. Bedlack, David L. Simel
Clinical Scenarios
Topics Discussed:
diplopia, eyelid ptosis, myasthenia gravis
Excerpt:
"A 45-year-old man has a 2-month history of fluctuating double
vision, a droopy right eye that improves with rest, and a complaint
that food gets stuck halfway down. Your examination confirms severe
right eyelid ptosis that dramatically improves with rest. His right
eye adduction and up gaze are markedly impaired. The left eye demonstrates
complete horizontal ophthalmoplegia. The limb muscle strength and
reflexes are normal. You wonder whether there is an accurate and
clinically useful bedside test to help confirm the diagnosis of myasthenia
gravis...."
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