title: An unusual primary presentation of myasthenia gravis.
abstract: This patient presented with progressive eating difficulties, having been originally investigated for mechanical gastroenterological problems. Fruitless examinations led to referral to a tertiary oral medicine unit and a detailed review of his history, where the significance of progressive fatiguability during and after mastication became apparent in his dysphagia. The insidious onset contrasted with his more rapid decline in function between the initial examination and specialist electromyographic investigations, neurological admission and management. The dangers of fatigue and pharyngeal incompetence are of particular relevance to oral and maxillofacial clinicians.
authors.affiliation: Department of Oral Medicine, King's College London Dental Institute, Guy's Hospital Campus, London, SE1 9RT, UK. richard_james.cook@kcl.ac.uk
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Cook
authors.forename: Helen
authors.initials: H
authors.lastname: McParland
authors.forename: Michael
authors.initials: M
authors.lastname: Escudier
mesh_terms: D000368:Aged; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D003680:Deglutition Disorders / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004576:Electromyography; D005221:Fatigue / Q000175:diagnosis; D006801:Humans; D008297:Male; D053580:Muscle Strength / Q000502:physiology; D009129:Muscle Tonus / Q000502:physiology; D009157:Myasthenia Gravis / Q000175:diagnosis*; D011729:Pyridostigmine Bromide / Q000627:therapeutic use; D012018:Reflex / Q000502:physiology
chemical_list: D002800:Cholinesterase Inhibitors; D011729:Pyridostigmine Bromide