Ocular myasthenia gravis in a person with tetraplegia presenting challenges in diagnosis and management

This case report describes a man with tetraplegia who developed ocular myasthenia gravis (OMG). The OMG diagnosis was complicated by his existing conditions and medications. Managing his OMG symptoms created new problems with bladder control and blood pressure. The patient's OMG was treated with pyridostigmine, which helped his eye symptoms but worsened his abdominal spasms and autonomic dysreflexia. Doctors had to stop the pyridostigmine and find another way to manage his double vision. Ultimately, the patient's OMG was managed with an eye patch to alleviate double vision. He continued to have health problems and died five months later from a heart attack.

• 1
  The patient's ocular signs responded well to pyridostigmine.
• 2
  Unopposed anti-cholinesterase activity led to frequent and painful abdominal spasms, associated with uncontrolled detrusor hyperreflexia and worsening autonomic dysreflexia (AD).
• 3
  Diagnostic difficulties may arise where the pattern of weakness mimics impairment of either third, fourth or sixth cranial nerve function, unilaterally or bilaterally.