Ptosis and cranial nerve IV palsy reveal juvenile myasthenia gravis.
(Ptôsis et paralysie du IV comme signes d'appel d'une myasthénie juvénile)

Bodack MI.
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA.
bodack@cchmc.org

BACKGROUND: Ptosis and strabismus are 2 common presenting complaints of preschool-age patients. In both cases, these conditions can be benign and require no further workup. However, sudden onset of these findings can indicate a more serious neurologic problem. If a patient presents with multiple neurologic signs, a sudden onset eye turn, or ptosis, the patient must undergo a workup to rule out a pathologic etiology, specifically a brain tumor. The workup should include neuroimaging. If the results of the neuroimaging are normal, and the findings are variable, myasthenia gravis should be considered, and additional testing should be ordered to assist in the diagnosis.

CASE REPORT: This case report presents a 3-year-old boy who presented with a sudden onset of ptosis and hypertropia. Diagnosis of myasthenia gravis was made based on clinical presentation and response to ice pack testing. The patient was treated with pyridostigmine (Mestinon; Valent Pharmaceuticals, Costa Mesa, California) and has shown improvement in his clinical signs.

CONCLUSIONS: Although rare, myasthenia should  be considered a diagnosis in children who present with variable ptosis or strabismus. Patients can be successfully treated with medication.

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