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Case Reports
. 2024 Jul 4;18(1):319.
doi: 10.1186/s13256-024-04617-w.

Analysis of events from sudden isolated dysarthria to diagnosis of myasthenic crisis: myasthenia gravis mimicking acute lacunar stroke-a case report

Simona Petkovic Miletic  1 , Sheikh Ruksana Binte Ahmed  2
Affiliations
Case Reports

Analysis of events from sudden isolated dysarthria to diagnosis of myasthenic crisis: myasthenia gravis mimicking acute lacunar stroke-a case report

Simona Petkovic Miletic et al. J Med Case Rep. .

Abstract

Background: Myasthenic crisis (MC) is a life-threatening complication of myasthenia gravis (MG), necessitating ventilation. Achieving a safe and timely diagnosis of myasthenic crisis with atypical, isolated presentation is a considerable challenge particularly in elderly patients, where myasthenia gravis can present with isolated dysarthria in rare instances, giving a clinical impression of lacunar stroke.

Case presentation: We present a compelling case of a 73-year-old Caucasian female presenting with abrupt onset of isolated dysarthria. Despite initial treatment for a presumed lacunar stroke, subsequent evaluations led to her diagnosis of a myasthenic crisis. Within 72 h of admission, the patient developed dysphagia and shortness of breath, requiring supplemental oxygen. The case highlights the sequential progression of events from the atypical presentation of isolated dysarthria and its course to the management of a myasthenic crisis.

Conclusion: Our reported case focuses on the discussion of myasthenia that mimicked a lacunar stroke and was finally diagnosed at a critical time of medical crisis. This case highlights the imperative notion that isolated dysarthria in elderly individuals warrants vigilant monitoring for possible myasthenia gravis, given the low incidence of lacunar stroke presenting with only dysarthria.

Keywords: Case report; Isolated dysarthria; Lacunar stroke; Myasthenia gravis; Stroke mimics.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Computerised tomography head on stroke call showing no acute bleed, but moderate small vessel disease
Fig. 2
Fig. 2
Single fibre electromyography study on right orbicularis oculi showed 8 paired potentials, diagnostic for myasthenia gravis
See this image and copyright information in PMC

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