Dysarthria and positive myasthenia serology in a 75-year-old man

By Aziz Shaibani, MD, FAAN
A 75-year-old man presented with six-month history of speech difficulty, dysphagia, and fatigue that was more pronounced in the evenings. There was no diplopia or ptosis. He developed progressive dyspnea and lost 10 pounds over six months. Repetitive nerve stimulation of the left spinal accessory nerve revealed 15 percent decremental response. Binding AChR antibody titer was increased to 0.5nml/L. He was diagnosed with MG and was transferred to our hospital for plasmaphoresis. Examination is shown. He also had hyperreflexia and mild proximal weakness in the arms. See the case solution here.


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