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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}gmail.com

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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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