The clinical case is characteristic for myasthenia gravis. It is a neuromuscular junction condition that manifests as fluctuating skeletal muscle weakness, frequently affecting the neck, bulbar, and ocular muscles. There are two clinical types: ocular and generalized. In about 85% of cases, ptosis and/or diplopia are the initial ocular symptoms to appear. Within two years, 80% of these people will acquire generalized myasthenia. The ptosis may be unilateral or bilateral and alternate between the two eyes. On examination, a protracted upgaze may exacerbate ptosis. Due to unequal weakness of the extraocular muscles on either side rather than a specific cranial nerve disease, the diplopia might be horizontal or vertical. Extraocular eye movements are feeble during examination, however the ophthalmoplegia does not correspond to a specific cranial nerve's distribution. After activity or later in the day, the symptoms frequently appear. Bulbar symptoms, such as dysphagia, dysarthria, and fatigable chewing, are present in 15% of patients. Because the palate muscles are weak, the patient's voice may sound nasal. Patients may occasionally have liquid regurgitation via the nose when swallowing, which is also caused by weak palate muscles. When prompted to grin during an exam, the patient can exhibit the "myasthenic sneer," in which the midlip raises while the outside regions of the lips remain immobile. Although proximal muscles are often more afflicted than distal ones and arms are typically more affected than legs, less than 5% of individuals only have proximal limb weakness. Involvement of the neck's extensors and flexors might result in "dropped head syndrome," especially later in the day.
Patients typically complain of widespread weakness, which gets worse with further exercise. Its two peaks are as follows: 20 to 30 years, with more women affected than males; 60 to 80 years, with more men affected than women.
