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Myasthenia gravis presenting as bilateral pseudointernuclear ophthalmoplegia in a patient with an incidental prolactinoma
  1. Julian Fernando Arias Chavez1 and
  2. Cornelius James Fernandez2
  1. 1Graduate Entry Medicine, University of Nottingham, Derby, UK
  2. 2Endocrinology, United Lincolnshire Hospitals NHS Trust, Boston, Lincolnshire, UK
  1. Correspondence to Julian Fernando Arias Chavez; Mzyjfa{at}


Myasthenia gravis (MG) is a rare and potentially dangerous autoimmune condition, which affects the acetylcholine receptors at the neuromuscular junction of skeletal muscle. MG’s diverse symptomatology may readily masquerade as other neurological conditions, posing a diagnostic challenge to clinicians. We describe a 24-year old man who presented to the emergency department with a new onset internuclear ophthalmoplegia. After a series of investigations, we eventually arrived at a diagnosis of MG with pseudointernuclear ophthalmoplegia with an incidentally detected prolactinoma. We explore the literature regarding the pathophysiology of pseudointernuclear ophthalmoplegia, the link between prolactin and autoimmunity and the association between prolactinoma and MG.

  • pituitary disorders
  • cranial nerves
  • neuromuscular disease
  • immunology
  • emergency medicine

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  • Contributors JFAC initially assessed and consented the patient, brought forward the case for publishing and wrote the initial submitted draft, redrafted the document and sourced investigation images. CJF guided the investigations and diagnosis of the patient, as well as provided guidance on the structure of the article as well as critical editing of the final draft of the article.

  • 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; externally peer reviewed.

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