Abstract Details

Title Bilateral sixth nerve cranial palsy: Should we think of Myasthenia Gravis?

Topic Autoimmune Neurology

Presentation(s) P2 - Poster Session 2 (5:30 PM-6:30 PM)

Poster/Presentation
Number 15-103

Objective To present an unusual presentation of Myasthenia Gravis

Background
Myasthenia gravis (MG) is a disease of the neuromuscular junction that causes fatige and fluctuating muscle weakness affecting extrinsic ocular, respiratory or peripheral muscles. More than half of MG patients experience ptosis, which may be unilateral or bilateral. Uncommon clinical presentations include isolated forms of dyplopia, ataxia, vocal cord palsy, dysphagia and respiratory failure.

Design/Methods
We present the case of a 49 year-old female patient, with sudden-onset diplopia and weakness on right eye abduction with associated symptoms of sinusitis. She received a course of antibiotics, with temporary relief of symptoms which recurred a few days later. The patient was examined by her primary care physician reporting ptosis and bilateral sixth cranial nerve palsy which was more severe on the right side, with no peripheral muscle weakness, dysphagia or fatigability.

Results
The ice pack test was positive, a brain MRI was within normal limits and a repetitive nerve stimulation test of the right orbicularis oculis muscle showed a neuromuscular junction post-synaptic defect. Anti-MuSK antibody titers were positive and a diagnosis of MG was established.

Conclusions
MG is a neuromuscular junction disease, more frequent in middle-aged females. 50-85% of patients present with ocular symptoms, with or without peripheral muscle weakness, mainly afecting levator palpebrae superioris and other extrinsic eye muscles. Bilateral sixth cranial nerve palsy is an unusual presentation of this condition, a prompt identification of which leads to early diagnosis and prevention of further complications

Authors/Disclosures
Lithey Poveda PRESENTER	No disclosure on file
Emilio Herrera, Jr.	No disclosure on file
Guillermo Gonzalez-Manrique	Guillermo Gonzalez-Manrique has nothing to disclose.
Freddy Escobar-Montealegre	No disclosure on file

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