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The simultaneous presentations of myasthenia gravis (MG) and stroke is rare and can bediagnostically challenging. In November 2022, a 71-year-old male presented with left-sided facial numbness, dysarthria, dysphagia, and right-sided body weakness; neuroimagingindicated a left pontine stroke. During admission he displayed modest clinical improvement with resolution on imaging. Post-admission he experienced intermittent dysarthria and dysphagia which were diagnosed as transient ischaemic attacks. In 2023, he experienced a similar episode, now with added ptosis and mild breathing difficulty, but with unchanged imaging findings. Although diagnosed with a stroke reinfarction, his condition deteriorated.Fluctuating symptoms led to a suspicion of MG. A pharmacological challenge with pyridostigmine which was positive and the diagnosis of MG was confirmed with a positive acetylcholine receptor antibody test; thymoma was absent. The patient's symptoms have since been well-managed with pyridostigmine, prednisone, and azathioprine. This case highlights the diagnostic challenges and potential for delayed or missed diagnosis of MG due to overlapping symptoms with pontine strokes.
Eran Frank Shorer (Thu,) studied this question.