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Myasthenia gravis: an icy diagnosis
  1. Miguel García-Grimshaw,
  2. Diego Posadas-Pinto
  1. Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
  1. Correspondence to Miguel García-Grimshaw, Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga #15, Tlalpan, Mexico City 14080, Mexico; miguelgrimshaw{at}

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A previously healthy 63-year-old woman presented to the emergency department with a 10-month history of weakness that worsened throughout the day, dysphagia, slurred speech, bilateral ptosis and diplopia. Neurological examination revealed generalised muscle weakness, facial diplegia, limited abduction of the right eye and a limited upward movement of the right eye. A bilateral 5-min ice-pack test was performed, showing an improvement of the upper eyelid elevation (7 mm) for both eyes (figure 1). Further testing for anti-acetylcholine receptor (AChR) …

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  • Contributors All authors have contributed to the conception and design of the work and the analysis of the data in a manner substantial enough to take public responsibility for it; each believes the manuscript represents valid work, and each has reviewed the final version of the manuscript and approves it for publication. All authors had full access to all the data and take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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