# Myasthenic Crisis in a Patient Initially Treated for Transient Ischaemic Attack and Infection: A Case Report

## TL;DR

A patient initially treated for a stroke and infection was later diagnosed with a myasthenic crisis, highlighting the need for thorough neurological evaluation.

## Contribution

This case report emphasizes the importance of early neurological assessment in atypical presentations of myasthenia gravis.

## Key findings

- The patient's symptoms were initially misdiagnosed as a transient ischaemic attack and infection.
- Diagnosis of myasthenic crisis was confirmed through antibody testing and electromyography.
- Timely immunotherapy led to clinical improvement and successful extubation.

## Abstract

Myasthenia gravis (MG) is the most common disorder of the neuromuscular junction and may present with fluctuating ocular, bulbar, or limb weakness. Myasthenic crisis represents a life-threatening complication characterised by respiratory failure requiring ventilatory support. We report the case of a 46-year-old South Asian man who initially presented with fluctuating bilateral ptosis, intermittent diplopia, and fatigue, and was managed as a transient ischaemic attack and respiratory tract infection. He subsequently deteriorated with hypoxia, extensive secretion burden, and pneumonia, necessitating intubation and intensive care admission. Despite broad-spectrum antibiotics and supportive care, ventilatory requirements persisted. Following neurological review and a more detailed history, together with multidisciplinary discussion, a myasthenic crisis was suspected, and treatment with intravenous immunoglobulin and corticosteroids was initiated. Acetylcholine receptor antibodies later returned positive, and electromyography demonstrated a decremental response, confirming the diagnosis. The patient improved gradually, was extubated on Day 14, and discharged with immunosuppressive therapy and neurology follow-up. This case underscores the importance of thorough neurological examination and careful history-taking to support early diagnosis, alongside timely multidisciplinary team input to guide management.