title: Diagnosis of Tensilon-Negative Ocular Myasthenia Gravis By Daily Selfie.
abstract: The initial symptoms of myasthenia gravis are usually ptosis and diplopia. The diagnosis is often confirmed by testing for anti-acetylcholine receptor antibodies or by observing the effects of intravenous edrophonium (Tensilon) injection. However, these standard tests may be negative in patients with isolated ocular findings. We present the case of an 83-year-old woman with negative serologic and Tensilon testing. She was asked to photograph herself daily. The resulting sequence of daily selfies captured striking fluctuations in her ocular alignment and ptosis. Daily selfies may be a useful strategy for confirming the clinical diagnosis of ocular myasthenia gravis.
authors.affiliation: Departments of Neurology (ELG, JCH) and Ophthalmology (JVB), University of California, San Francisco, California.
authors.forename: Elan L
authors.initials: EL
authors.lastname: Guterman
authors.forename: James V
authors.initials: JV
authors.lastname: Botelho
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Horton
mesh_terms: D000369:Aged, 80 and over; D001763:Blepharoptosis / Q000175:diagnosis / Q000209:etiology; D003937:Diagnosis, Differential; D004172:Diplopia / Q000175:diagnosis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D009157:Myasthenia Gravis / Q000150:complications / Q000175:diagnosis*; D010781:Photography / Q000379:methods*; D000068997:Smartphone