1. What is the likely diagnosis? What is the pathogenesis of this disease?
In this case, the likely diagnosis is Myasthenia Gravis. Myasthenia Gravis is an autoimmune disease where the body of a person generates antibodies towards post synaptic Ach receptors. Likewise, the produced antibodies attack acetylcholine at the synaptic cleft. The cumulative effects of the disease reduce the number of functional Ach and functional Ach receptors. The myasthenia gravis pathogenesis relies on the isotype and bulbar of the autoantibodies.
2. What other neurologic manifestations might one expect to see?
Myasthenia gravis (MG) is a typical disorder of neuromuscular transmission (Wolfe et al., 2016). The hallmark of myasthenia disorder is the undulating degree and variable combination of bulbar, respiratory, ocular, and limb muscle weaknesses. The weaknesses result from antibody-mediated and the T cell-dependent immunologic attack that is directed at proteins in the neuromuscular postsynaptic membrane junction. Myasthenia gravis diagnosis can be created by both serologic and clinical testing (Punga, Anna and Tanel, 2018). There are two myasthenia gravis forms. One of the forms is ocular myasthenia whose weakness is limited to the extraocular and eyelids muscles. In the generalized myasthenia gravis disease, the weakness affects ocular muscles which involve the combination of limb, respiratory and bulbar muscles.
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3. What is the mechanism by which this patient’s ocular muscle weakness increases with
Prolonged activity?
The mechanism by which the ocular muscle of the patient increases with prolonged activity is ptosis. Ptosis is a typical manifestation of MG. It occurs mainly as a result of the involvement of the levator palpebrae superioris complex. Ptosis heightens after the prolonged upgaze notably known as the fatigability test (Vander et al., 2017).
4. What associated conditions should be investigated in this patient?
Numerous conditions are associated with patients investigated with myasthenia gravis. One of the conditions associated with this disease is thyroid disease. Thyroid disease is a medical condition that impedes the thyroid gland from making the right quantity of hormones. The other associated conditions include diabetes, hypertension, dyslipidemia, heart diseases, and respiratory disease. Since myasthenia gravis is a clinically treatable disease, patients with this particular condition ought to visit physicians to be treated early before it becomes severe.
References
Punga, A. R., & Punga, T. (2018). Circulating microRNAs as potential biomarkers in myasthenia gravis patients. Annals of the New York Academy of Sciences, 1412(1), 33-40.
Vander Heiden, J. A., Stathopoulos, P., Zhou, J. Q., Chen, L., Gilbert, T. J., Bolen, C. R., ... & Vigneault, F. (2017). Dysregulation of B cell repertoire formation in myasthenia gravis patients revealed through deep sequencing. The Journal of Immunology, 198(4), 1460-1473.
Wolfe, G. I., Kaminski, H. J., Aban, I. B., Minisman, G., Kuo, H. C., Marx, A., ... & Heckmann, J. M. (2016). Randomized trial of thymectomy in myasthenia gravis. New England Journal of Medicine, 375(6), 511-522.
