不典型眼肌型重症肌无力临床分析

目的：探讨仅表现为复视的不典型眼肌型重症肌无力的诊断和治疗。方法回顾性分析8例仅表现为复视的重症肌无力患者的临床资料。结果8例患者均仅表现为复视，无眼睑下垂、无明显眼外肌麻痹，经溴吡啶斯的明、激素治疗，随访1.5年，症状完全缓解3例，明显改善4例，1例转为全身型重症肌无力，治疗过程中1例发生胃溃疡，2例体重增加。结论仅表现为复视而无眼睑下垂、无眼外肌麻痹的眼肌型重症肌无力患者易导致误诊和漏诊，对这些患者在诊疗过程中需要仔细询问病史、详细神经系统检查，对疑似病例做疲劳试验和新斯的明试验等相关检查，以明确或排除重症肌无力。

Objective To explore the diagnosis and therapy of atypical ocular myasthenia gravis which only manifested as diplopia. MethodsThe data of 8 patients with atypical ocular myasthenia gravis which only manifested as diplopia were retrospectively analyzed.Results A totle of 8 patients only presented with diplopia without blepharoptosis and ophthalmoplegia.After treating with Pyridostigmine bromide and hormone,follow-up 1.5 years,the symptoms were disappeared in 3 cases,remarkably improved in 4 cases and one case conversed to secondary generalized myasthenia gravis. Gastric ulcer occurred with a case,weighting occurred with 2 cases during the treatment.Conclusions Atypical ocular myasthenia gravis which only manifested as diplopia is easy to misdiagnosis and missed diagnosis.For these patient,we need inquiry detailted history and carefully physical examination of the nervous system.fatigue-recovery test and the neostigmine test are helpful in diagnosis of myasthenia gravis for Suspected cases.