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Myasthenia Gravis

Peter G. Gilbert, MD
JAMA. 1968;206(11):2525. doi:10.1001/jama.1968.03150110073026.
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To the Editor:—  It is the intention of this brief note to show how elusive myasthenia gravis can be.

Report of a Case:—  An intelligent electronic engineer (aged 29) became suddenly aware of vertical diplopia, corrected by hyperextension of the neck. At an eye clinic, he demonstrated 4 diopters for near and 5 diopters for far vision. Eight days later the vertical diplopia measured 10 diopters for near and 9 diopters for far vision. By this time the patient was aware that he could correct the diplopia by lying in the left lateral decubitus position. Cerebellar functions were within normal limits and no abnormalities of sensation were found. Lumbar puncture showed the spinal fluid pressure to be 214 to 218 mm H2O opening and closing at 184 mm H2O.Nine days after the initial visit, the diplopia was gone, but he could not manipulate his tongue


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