Myasthenia Gravis Diagnosis in a 41-Year-Old Woman Highlights Importance of Early Treatment for Sudden Eyelid Drooping
Myasthenia gravis (MG) is a chronic autoimmune disorder that affects the neuromuscular junction, causing muscle weakness that worsens with activity and improves with rest. One of the most common early symptoms is ptosis, or drooping of the eyelids. This case study follows a 41-year-old woman whose initial symptom was sudden eyelid drooping, which eventually led to a diagnosis of myasthenia gravis.
Case Overview
This case involves a 41-year-old female patient who visited a hospital in May 2020 after experiencing sudden vision changes and eyelid drooping. She initially ignored the symptoms until they began interfering with her daily tasks, particularly farm work. After a series of neurological tests and imaging studies, she was diagnosed with ocular myasthenia gravis. Her treatment plan included medication and a thymoma surgery at a higher-level medical facility.
Patient Profile
- Age & Gender: Female, 41 years old
- Diagnosis: Myasthenia gravis (ocular type)
- Hospital: Shandong Third Provincial Hospital
- Admission Date: May 2020
- Treatment: Pyridostigmine bromide tablets, dexamethasone sodium phosphate injection, ginkgo biloba extract injection, followed by thymoma surgery
- Recovery: Hospitalization lasted 7 days; follow-up after 1 month showed stable condition with no eyelid drooping
Initial Consultation and Symptoms
The patient reported sudden difficulty lifting her eyelids and blurred vision. Initially, she did not seek medical attention, but as her symptoms progressed and began to interfere with her daily life, she visited the hospital. Upon neurological examination, bilateral ptosis and a positive fatigue test were observed. These findings raised suspicion for myasthenia gravis. The patient was advised to be admitted for further diagnostic tests and treatment planning.
Diagnostic Process and Treatment Plan
Detailed tests were conducted during hospitalization, including blood work and neuromuscular assessments. Routine blood tests, including liver and kidney function, electrolytes, lipids, glucose, and cardiac enzymes, showed no significant abnormalities. A positive neostigmine test and abnormal repetitive nerve stimulation results confirmed the diagnosis of myasthenia gravis. A chest CT scan also revealed a thymoma, which is often associated with MG.
She was treated with pyridostigmine bromide to improve neuromuscular transmission, along with dexamethasone sodium phosphate and ginkgo biloba extract to reduce inflammation and support nerve function. After seven days of treatment, her eyelid function improved significantly. She was advised to undergo thymoma surgery, which she opted to have at a higher-level hospital.
Post-Treatment Recovery and Follow-Up
By the third day of treatment, the patient experienced noticeable improvement in eyelid drooping. By the seventh day, she could fully lift both eyelids. Given the positive response to medication and the presence of a thymoma, she was advised to proceed with surgical removal. One month after discharge, a follow-up call confirmed she had undergone successful thymoma surgery and remained stable without recurrence of ptosis.
Understanding Myasthenia Gravis
Myasthenia gravis is an autoimmune disorder where the body's immune system mistakenly attacks the neuromuscular junctions. While this patient presented with isolated ocular symptoms, the condition can progress to affect other skeletal muscles, including those involved in breathing. If left untreated, it can lead to myasthenic crisis—a life-threatening condition requiring emergency medical intervention.
Key Patient Guidelines
Patients diagnosed with myasthenia gravis should monitor their symptoms closely, especially for signs of worsening muscle weakness or breathing difficulties. It is crucial to adhere to prescribed medications and attend regular follow-up appointments. Lifestyle modifications such as stress reduction, adequate rest, balanced nutrition, and moderate physical activity can support immune function and overall recovery.
Clinical Insights and Recommendations
This case highlights the importance of early diagnosis and treatment. The patient delayed seeking care due to financial concerns, which is a common issue in many communities. As healthcare providers, it is essential to educate patients about the risks of untreated myasthenia gravis and encourage timely medical evaluation. Regular follow-ups and open communication can help prevent complications and improve long-term outcomes.
Final Thoughts
While this patient's condition was successfully managed, her story serves as a reminder that sudden eyelid drooping should not be ignored. Early intervention can make a significant difference in prognosis. Raising awareness about myasthenia gravis and ensuring access to affordable healthcare are vital steps in preventing avoidable complications and improving patient outcomes.