Teaching NeuroImages: Reversible ectropion in myasthenia gravis
G. Solé, MD,
F. Perez, MD and
X. Ferrer, MD
From the Centre de Référence des Maladies Neuromusculaires, Pôle Neurosciences Cliniques, CHU de Bordeaux, Pessac, France.
Address correspondence and reprint requests to Dr. Guilhem Solé, Centre de Référence des Maladies Neuromusculaires, Pôle Neurosciences Cliniques, CHU de Bordeaux, Avenue de Magellan, 33604 Pessac cedex, France guilhem.sole{at}chu-bordeaux.fr.
A 77-year-old woman was admitted with 1 month of progressivegeneralized weakness, camptocormia, dysarthria, dysphagia, andtransient ectropion (figure 1). These symptoms and signs worsenedafter exercise. Repetitive nerve stimulation showed a decrementalresponse (–32% for the nasalis and –54% for thedeltoid), and serum acetylcholine receptor antibodies were positive,leading to the diagnosis of myasthenia gravis. Subcutaneousinjection of 0.25 mg neostigmine improved signs consistentlyand ectropion disappeared (figure 2). This response was confirmed1 month later after treatment with 300 mg pyridostigmine daily.Ectropion can be a sign of facial weakness in myasthenia gravis.1
Figure 2 Dramatic improvement after injection of 0.25 mg of neostigmine
Created with Photoshop elements.
Disclosure: Dr. Solé received non–industry-sponsoredfunding for travel. Dr. Perez received funding for travel fromNovartis. Dr. Ferrer reports no disclosures.
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