title: Myasthenia gravis as a 'stroke mimic'--it's all in the history.
abstract: An 85-year-old man presented to hospital as an emergency having difficulties with swallowing and speech. In the emergency department, he was assessed as having acute onset dysphagia and dysarthria in keeping with an acute stroke. Subsequently, it became apparent that although the symptoms were indeed of relatively acute onset, there was a clear description by the patient of fatigability and diurnal variation, prompting a working clinical diagnosis of myasthenia gravis. The patient followed a turbulent clinical course, and interpretation of investigation results proved not to be straightforward in the acute setting. Myasthenia gravis is an uncommon disorder but it is more common in the elderly. This case provides key learning points, particularly highlighting the value of prompt, accurate clinical assessment and the importance of adhering to the clinical diagnostic formulation.
authors.affiliation: Department of Neurology, Royal Preston Hospital, Preston, UK;
authors.forename: Saiffuddin
authors.initials: S
authors.lastname: Shaik
authors.affiliation: Department of Neurology, Royal Preston Hospital, Preston, UK;
authors.forename: Mian Ayaz
authors.initials: MA
authors.lastname: Ul-Haq
authors.affiliation: Department of Neurology, Royal Preston Hospital, Preston, UK, and University of Manchester, Manchester, UK hedley.emsley@manchester.ac.uk.
authors.forename: Hedley C A
authors.initials: HC
authors.lastname: Emsley
mesh_terms: D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology; D003680:Deglutition Disorders; D003937:Diagnosis, Differential; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009157:Myasthenia Gravis / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D020521:Stroke / Q000175:diagnosis*
keywords: Stroke mimic; acute neurology; clinical history; myasthenia gravis