Practical Neurology Podcast Diagnosing neuromuscular junction disorders: red flags and atypical presentations
Dec 11, 2024
Joining the discussion are Shadi El-Wahsh, an early career neurologist and clinical neurophysiologist from Sydney, and Stephen Reddel, a neurologist specializing in neuroimmunology. They dive into the complexities of diagnosing neuromuscular junction disorders, emphasizing the red flags and atypical presentations that can lead to misdiagnosis. Their insights include the significance of antibody testing and distinguishing between true junction disorders and mimics, particularly in relation to symptoms like ptosis and visual disturbances.
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Bienfang Test for Myasthenia Gravis
- Observe for fatigable ptosis and use the Bienfang test (forceful eye closure for 30 seconds).
- Look for transient improvement in ptosis and a peak sign upon opening the eyes.
Observing Myasthenia Signs During History-Taking
- Steve Reddel observes signs of myasthenia during history-taking, like progressive ptosis and increased frontalis effort.
- Fatigable speech is characteristic of bulbar myasthenia, unlike non-fatigable speech in other conditions.
Red Flags in Myasthenia Gravis Diagnosis
- Be wary of pain on eye movements, proptosis, pupillary/optic nerve involvement in ocular myasthenia.
- In generalized myasthenia, consider pain, marked limb asymmetry, and reflex changes as red flags.