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Abstract Details

Myasthenia Gravis Presenting as Recurrent Falls in a Young Man
General Neurology
P1 - Poster Session 1 (5:30 PM-6:30 PM)
4-055
To discuss an atypical presentation of myasthenia gravis (MG).

MG has an annual incidence of 10 per million people. Females are more often diagnosed before age fifty and males after age fifty. Typical presentations involve fluctuating weakness and fatigability, usually affecting the eyes (ptosis and diplopia) and proximal muscles. Diagnosis is based upon history and exam, and supported by antibodies for acetylcholine receptor and muscle-specific kinase, and EMG studies. Atypical cases of MG may lead to delayed diagnosis. We found reports of MG presenting as recurrent falls in the elderly, but no reports of recurrent falls being the presenting symptom in the young. The patient is a 31-year-old male with no medical history who presented after falling down stairs. He reported recurrent falls for six months, characterized by dizziness, blurry vision, then going “limp,” collapsing to the ground without loss of consciousness. He endorsed episodes of generalized weakness and diplopia, which typically occurred after exertion and could persist for days. Weakness required long periods of rest to resolve. He denied palpitations and seizure stigmata. On exam, there were no focal deficits; he did not have ptosis, dysconjugate gaze, or diplopia, and motor strength was 5/5 in all muscle groups without fatigability. Previous cardiac workup was unremarkable.

Not applicable
Diagnostic testing evaluated for neuromuscular junction disorders, inflammatory myopathies, and seizures. EEG, ESR, CRP, and CK were normal. Acetylcholine receptor antibody was positive (73 nmol/L). EMG demonstrated post-synaptic neuromuscular junction dysfunction, with decremental response of 15% on 2Hz repetitive nerve stimulation. EMG and positive acetylcholine receptor antibody testing confirmed the diagnosis of MG. He was started on pyridostigmine and had no further episode of weakness or falls.

Atypical presentations of MG may be subject to delayed diagnosis. MG should be considered in the differential for patients presenting with recurrent falls with exertion.

Authors/Disclosures
Daryl C. McHugh, MD (Montefiore Medical Center)
PRESENTER
Dr. McHugh has nothing to disclose.
Aleksandr Isakov, MD (Aleksandr Isakov) No disclosure on file
Rohit Reddy, MD (Dartmouth-Hitchcock Medical Center) No disclosure on file
Steven Xian, MD (Mount Sinai Doctors) No disclosure on file
Fabreena Napier, MD (Jacobi Medical Center) Dr. Napier has nothing to disclose.
Lenore C. Ocava, MD (NYC Health+Hospital/Jacobi/Albert Einstein COM/) No disclosure on file