A case of elderly-onset myasthenia gravis mimicking stroke with dysarthria and left upper extremity paresis

An 80-year-old woman presented with sudden-onset dysarthria and left-side dominant quadriparesis transferred to our hospital. A neurologic examination revealed slurred speech, prominent left upper extremity weakness mild of the other extremities. Brain MRI a history right-side cerebral artery bypass surgery, but no new lesions indicative stroke. Left had improved soon after admission, so transient ischemic attack was suspected. After fluctuated. The patient's respiratory condition deteriorated several days later she required ventilation support. Assessment cause failure positive muscle-specific kinase (MuSK) antibodies, which suggested myasthenia gravis (MG). symptoms gradually immunotherapy we were able completely withdraw her from ventilator few months. There some reports that dysphagia present suddenly like stroke without fluctuation in elderly-onset MG. It is necessary note MG diagnosis may be difficult if elderly patients have multiple comorbidities unclear diurnal fluctuations.