TITLE:
Multiple Cranial Nerve Palsies in Otolaryngology Consultation: An Atypical Clinical Presentation Revealing Myasthenia Gravis
AUTHORS:
Adèle-Rose Ngo Nyeki, Paul Cedric Mbonda, Léonel Atanga, Yannick Mossus, Roger Meva’a, Victor Sini, Mambo Olive Ngaba, David Mindja, Francois Djomou, Callixte Kuate, Richard Njock, Alexis Ndjolo
KEYWORDS:
Clinical Case, Dysphagia, Swallowing Disorders, Facial Diplegia, Nasal Voice, Myasthenia, Autoimmune, Paralysis, Cranial Nerves
JOURNAL NAME:
International Journal of Otolaryngology and Head & Neck Surgery,
Vol.11 No.6,
November
29,
2022
ABSTRACT: Introduction: Myasthenia gravis is a chronic autoimmune neuromuscular disease, presents with weakness and fatigability of striated skeletal muscles. It is a rare disease in Cameroon. We report an uncommon case of myasthenia gravis in a patient with feeding difficulties, notion of oronasal reflux and swallowing disorders as first complaints. Observation: We report the case of a 29-year-old woman consulted at our department of Otolaryngology and Cervico-Facial Surgery for dysphagia and swallowing disorders. She also presented with facial diplegia, oculomotor paralysis, nasal voice, and dysarthria which has been evolving for several years now. The clinical examination revealed multiple cranial nerve palsies. The complementary workup showed a decrement of more than 50% in the electroneuromyography and the presence of anti-acetylcholine receptor autoantibodies in the blood workup. A diagnosis of myasthenia confirms clinical presumption. We initially observed a worsening of neuromuscular disorders despite the pyridostigmine treatment and subsequently a clear improvement of the clinical features concerning swallowing and speech disorders, oculomotricity and facial diplegia under a treatment combining prednisone and azathioprine. Conclusion: Myasthenia gravis is a rare and potentially fatal autoimmune neuromuscular disease. We thus highlight the atypical clinical presentation and therapeutic itinerary of our patient and the importance to think about this clinical diagnosis in front of any multiple cranial nerve paralysis in otolaryngology consultation.