Case 32-1975

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Abstract
Presentation of CaseA 68-year-old man was admitted to the hospital because of loss of consciousness.Four years previously he began to experience difficulty in keeping his eyes open, slowing of motor activity and imbalance on walking. A physician prescribed levodopa, without effect, and the medication was discontinued. Intermittent diplopia and dysphagia developed. Two and a half years before admission a test with edrophonium chloride was interpreted as positive, but an electromyographic study of several muscles, including the orbicularis oculi, showed no abnormality. Pyridostigmine bromide followed by neostigmine caused no improvement. The ptosis became more marked; splints and an operation . . .
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