title: "Why do I always see double?" A misdiagnosed case of ocular myasthenia gravis for 10 years.
abstract: A 58-year-old man presented with diplopia and partial ptosis for 10 years. It was non-progressive in nature, despite inadequate medical attention the patient received from non-specialists/general practitioners. He did not have fatigability or diurnal variation in weakness and was clinically stable without exacerbations of disease for a decade. He did not have features of Graves's disease, oculopharyngeal dystrophy, cranial nerve paralysis, polymyositis and stroke. The possibility of an atypical presentation of myasthenia gravis (MG) was considered and the patient was evaluated. Ice pack test was negative, Cogan's lid twitch (CLT) test was positive and high titres of acetylcholine receptor antibodies (AChR Ab) suggestive of MG were found. He was treated accordingly with a very good response.
authors.affiliation: Department of Medicine, Melaka Manipal Medical College, Melaka, Malaysia.
authors.forename: Uduman Ali Mohamed
authors.initials: UA
authors.lastname: Yousuf
authors.forename: B M
authors.initials: BM
authors.lastname: Yashodhara
authors.forename: Thevi
authors.initials: T
authors.lastname: Thanigasalam
authors.forename: Heng Siang
authors.initials: HS
authors.lastname: Ting
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001763:Blepharoptosis / Q000188:drug therapy / Q000209:etiology; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D004172:Diplopia / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009157:Myasthenia Gravis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D015840:Oculomotor Nerve Diseases / Q000175:diagnosis*; D011239:Prednisolone / Q000627:therapeutic use; D011729:Pyridostigmine Bromide / Q000627:therapeutic use
chemical_list: D000893:Anti-Inflammatory Agents; D002800:Cholinesterase Inhibitors; D011239:Prednisolone; D011729:Pyridostigmine Bromide