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Exotropia and Bilateral Ptosis in Myasthenia Gravis Patient

A 12-year-old male presented with the right eye turned outward called exotropia and both upper eyelids drooping, which is called bilateral ptosis. This young male had been twice to the emergency room and had been examined by 2 pediatricians and one pediatric neurologist.

A 12-year old male presented with the right eye turned outward called exotropia and both upper eyelids drooping, which is called bilateral ptosis. This young male had been twice to the emergency room and had been examined by 2 pediatricians and one pediatric neurologist. No diagnosis had been made after a normal CT scan and a normal MRI of the brain. The patient was referred to Dr. Pollard who examined the patient and diagnosed Myasthenia Gravis and found high serum titers of antibodies to acetylcholine receptor sites. The patient was admitted to the hospital as he was having trouble with slurred speech and swallowing. Consultation with the neurology service at Scottish Rite Hospital confirmed our diagnosis and he was treated in the Intensive Care Unit with systemic steroids, Mestinon, a drug for Myasthenia Gravis and plasma phoresis. So far he has had complete remission of his symptoms. In Myasthenia Gravis there is not enough of the chemical acetylcholine to work at the neuro-muscular junction. Many muscles are affected with paralysis or paresis such as droopy eyelids (weakness of the muscle that opens the eyelids), weakness of the right medial rectus muscle and weakness of the muscles of speech and swallowing.

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