Distal myasthenia gravis: case report

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 sev...

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Bibliographic Details
Published in:Arquivos de neuro-psiquiatria 2003-03, Vol.61 (1), p.119-120
Main Authors: Scola, Rosana Herminia, Iwamoto, Fábio Massaiti, Mainardi, Maraya Annaai Michels, Della-Coletta, Marcus Vinicius, Carvalho, Gisah, Zavala, Jorge Augusto, Werneck, Lineu Cesar
Format: Article
Language:eng ; por
Subjects:
Adult
Diagnosis, Differential
Electric Stimulation - methods
Female
Humans
Leg
Muscle Contraction
Muscle Weakness - diagnosis
Muscle Weakness - etiology
Myasthenia Gravis - complications
Myasthenia Gravis - diagnosis
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Summary: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.
ISSN:0004-282X
DOI:10.1590/S0004-282X2003000100024