title: [Distal myasthenia gravis: case report].
abstract: We report the case of a 30-year-old woman with a 7-year history of distal lower limbs weakness that evolved to upper limbs weakness. On neurological examination, she presented normal cranial nerves, bilateral quadriceps and feet interosseous atrophy, normal muscular tonus, muscular weakness more severe in dorsal feet interosseous and anterior tibial, and decreased deep tendon reflexes. Repetitive nerve stimulation of the ulnar and fibular nerves showed a decrement greater than 10% of the compound muscle action potential. Antibody against acetylcholine receptor titer was positive. Computed tomography scan of the thorax was normal. Thyroid function tests showed evidence of hyperthyroidism. Distal muscular weakness is a rare onset presentation of myasthenia gravis. However, myasthenia gravis must be considered in the differential diagnosis of distal limb weakness.
authors.affiliation: Hospital de Clínicas, Universidade Federal do Parana, Curitiba, PR, Brasil. scola@hc.ufpr.br
authors.forename: Rosana Herminia
authors.initials: RH
authors.lastname: Scola
authors.forename: Fábio Massaiti
authors.initials: FM
authors.lastname: Iwamoto
authors.forename: Maraya Annaai Michels
authors.initials: MA
authors.lastname: Mainardi
authors.forename: Marcus Vinicius
authors.initials: MV
authors.lastname: Della-Coletta
authors.forename: Gisah
authors.initials: G
authors.lastname: Carvalho
authors.forename: Jorge Augusto
authors.initials: JA
authors.lastname: Zavala
authors.forename: Lineu Cesar
authors.initials: LC
authors.lastname: Werneck
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D004558:Electric Stimulation / Q000379:methods; D005260:Female; D006801:Humans; D007866:Leg; D009119:Muscle Contraction; D018908:Muscle Weakness / Q000175:diagnosis / Q000209:etiology*; D009157:Myasthenia Gravis / Q000150:complications* / Q000175:diagnosis
vernacular_title: Miastenia grave distal: relato de caso.