ABSTRACT
PURPOSE: To report two patients with positive ice tests who had diplopia and blepharoptosis caused by something other than ocular myasthenia gravis. CASE SUMMARY: A 35-year-old female presented with a one-week history of inability to adduct the left eye and left blepharoptosis. Although the ice test was positive, serum anti-acetylcholine receptor binding antibody and the repetitive nerve stimulation test were negative. Brain angiography showed an aneurysm of the left posterior communicating artery, leading to the diagnosis of left pupil-sparing oculomotor nerve palsy. A 25-year-old female presented with an 8-month history of intermittent horizontal diplopia and blepharoptosis in the right eye. The ice test was positive, however serum anti-acetylcholine receptor binding antibody and the repetitive nerve stimulation test were negative. Anti-nuclear antibody was positive (titer 1:160). CONCLUSIONS: The ice test is a useful screening test for myasthenia gravis. However, a series of differential diagnoses including blepharoptosis and ocular motility disorder should be considered because these conditions also show a positive result in the ice test.
Subject(s)
Adult , Female , Humans , Aneurysm , Angiography , Arteries , Blepharoptosis , Brain , Diagnosis , Diagnosis, Differential , Diplopia , Ice , Mass Screening , Myasthenia Gravis , Ocular Motility Disorders , Oculomotor Nerve DiseasesABSTRACT
PURPOSE: To compare the results of the ice test with other diagnostic tests for the diagnosis of myasthenia gravis in patients with ptosis. METHODS: The patients included in this study presented with suspicious myasthenic blepharoptosis and visited the Department of Ophthalmology, Guro Hospital, Korea University between March 2003 and February 2004 for diagnosis. All patients received "myasthenic ptosis workup" including the ice test, edrophonium test, RNS EMG, and anti-acetylcholine receptor antibody (anti-AchR) titer test. The tests were compared for specificity, sensitivity, ease of performance, economic benefits and observed complications. RESULTS: The patients included six men and nine women with an average age of 36.9+/-2.4 yrs. Positive test results were obtained as follows: Ice test 80%, edrophonium test 66.7%, RNS EMG 53.3%, and anti-AchR titer test 86.7%. Adverse effects of edrophonium test were encountered in two patients who had nausea, vomiting, and dizziness. CONCLUSIONS: The authors found that the ice test was simpler, faster, more economic, and safer than the others for diagnosing blepharoptosis caused by myasthenia gravis. Considering its relative high sensitivity and specificity, the ice test should be the first screening test given to patients with suspicious myasthenic ptosis.
Subject(s)
Female , Humans , Male , Blepharoptosis , Diagnosis , Diagnostic Tests, Routine , Dizziness , Edrophonium , Ice , Korea , Mass Screening , Myasthenia Gravis , Nausea , Ophthalmology , Sensitivity and Specificity , VomitingABSTRACT
PURPOSE: To compare the results of the ice test with other diagnostic tests for the diagnosis of myasthenia gravis in patients with ptosis. METHODS: The patients included in this study presented with suspicious myasthenic blepharoptosis and visited the Department of Ophthalmology, Guro Hospital, Korea University between March 2003 and February 2004 for diagnosis. All patients received "myasthenic ptosis workup" including the ice test, edrophonium test, RNS EMG, and anti-acetylcholine receptor antibody (anti-AchR) titer test. The tests were compared for specificity, sensitivity, ease of performance, economic benefits and observed complications. RESULTS: The patients included six men and nine women with an average age of 36.9+/-2.4 yrs. Positive test results were obtained as follows: Ice test 80%, edrophonium test 66.7%, RNS EMG 53.3%, and anti-AchR titer test 86.7%. Adverse effects of edrophonium test were encountered in two patients who had nausea, vomiting, and dizziness. CONCLUSIONS: The authors found that the ice test was simpler, faster, more economic, and safer than the others for diagnosing blepharoptosis caused by myasthenia gravis. Considering its relative high sensitivity and specificity, the ice test should be the first screening test given to patients with suspicious myasthenic ptosis.