SHM Converge Scientific Abstract ePoster Gallery-When Speech Fades First: Isolated Bulbar Myasthenia Gravis in an Elderly Female

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This case report describes an 88-year-old woman who presented with one week of slurred speech and difficulty swallowing. Because her symptoms suggested a transient ischemic attack or stroke, she underwent neurologic evaluation, but head CT and brain MRI showed no acute infarct or hemorrhage. Her examination was largely normal except for mild dysarthria.<br /><br />During hospitalization, her dysarthria persisted and she developed worsening dysphagia to both solids and liquids, especially later in the day. Gastrointestinal causes were investigated with EGD, which found a hiatal hernia, Barrett’s esophagus, and a tortuous esophagus, but these findings did not explain her fluctuating bulbar symptoms. This led clinicians to suspect neuromuscular junction disease, and pyridostigmine was started empirically. She experienced dramatic improvement after treatment.<br /><br />Autoantibody testing confirmed myasthenia gravis, showing elevated acetylcholine receptor blocking, binding, and modulating antibodies, while anti-MuSK antibodies were negative. She was diagnosed with isolated bulbar myasthenia gravis and her pyridostigmine dose was increased for symptom control. At one-month follow-up, she had no recurrence of dysarthria while adherent to treatment.<br /><br />The report emphasizes that isolated bulbar myasthenia gravis is rare and can be difficult to diagnose because dysarthria and dysphagia may mimic stroke, structural disease, or other neurologic disorders. It also highlights the unusual finding of strong positivity across all three AChR antibody assays. The authors note that this serologic pattern is uncommon, and in this case, the patient responded well to pyridostigmine, supporting the diagnosis and underscoring the importance of considering myasthenia gravis even when symptoms are limited to bulbar function in an elderly patient.

Asset Subtitle

Emma G. Carroscia

Meta Tag

Author List Akash Parashar, Carolyn DeBoth, Emma G. Carroscia

Category Clinical Vignettes

Concept Myasthenia Gravis

Concept Fatigable Weakness

Concept Ocular Weakness

Concept Bulbar Weakness

Concept Muscarinic Receptors

Distinguished Non-Finalist

Presenter Organization Lake Erie College of Osteopathic Medicine

Presenting Author Emma G. Carroscia

Track Adult

Keywords

myasthenia gravis

bulbar symptoms

dysarthria

dysphagia

acetylcholine receptor antibodies

pyridostigmine

stroke mimic

elderly patient

neuromuscular junction

autoantibody testing

Myasthenia Gravis

Fatigable Weakness

Ocular Weakness

Bulbar Weakness

Muscarinic Receptors