{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T06:40:21Z","timestamp":1756276821009,"version":"3.44.0"},"reference-count":39,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,10,20]]},"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:p>Myasthenia gravis (MG) is a rare and potentially dangerous autoimmune condition, which affects the acetylcholine receptors at the neuromuscular junction of skeletal muscle. MG\u2019s diverse symptomatology may readily masquerade as other neurological conditions, posing a diagnostic challenge to clinicians. We describe a 24-year old man who presented to the emergency department with a new onset internuclear ophthalmoplegia. After a series of investigations, we eventually arrived at a diagnosis of MG with pseudointernuclear ophthalmoplegia with an incidentally detected prolactinoma. We explore the literature regarding the pathophysiology of pseudointernuclear ophthalmoplegia, the link between prolactin and autoimmunity and the association between prolactinoma and MG.<\/jats:p>","DOI":"10.1136\/bcr-2020-234322","type":"journal-article","created":{"date-parts":[[2023,3,14]],"date-time":"2023-03-14T00:11:33Z","timestamp":1678752693000},"page":"e234322","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Myasthenia gravis presenting as bilateral pseudointernuclear ophthalmoplegia in a patient with an incidental prolactinoma"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1479-7041","authenticated-orcid":false,"given":"Julian Fernando","family":"Arias Chavez","sequence":"first","affiliation":[{"name":"Graduate Entry Medicine, University of Nottingham, Derby, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cornelius James","family":"Fernandez","sequence":"additional","affiliation":[{"name":"Endocrinology, United Lincolnshire Hospitals NHS Trust, Boston, Lincolnshire, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,12,17]]},"reference":[{"key":"2025082623163004000_13.12.e234322.1","doi-asserted-by":"crossref","first-page":"985","DOI":"10.4103\/0301-4738.145987","article-title":"Ocular myasthenia gravis: a review","volume":"62","author":"Nair","year":"2014","journal-title":"Indian J Ophthalmol"},{"key":"2025082623163004000_13.12.e234322.2","doi-asserted-by":"publisher","DOI":"10.1007\/BF01215447"},{"key":"2025082623163004000_13.12.e234322.3","doi-asserted-by":"crossref","first-page":"103","DOI":"10.18295\/2075-0528.1347","article-title":"Misdiagnosis of myasthenia gravis and subsequent clinical implication: a case report and review of literature","volume":"12","author":"Al-Asmi","year":"2012","journal-title":"Sultan Qaboos Univ Med J"},{"key":"2025082623163004000_13.12.e234322.4","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2010-1692"},{"key":"2025082623163004000_13.12.e234322.5","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2010-1048"},{"key":"2025082623163004000_13.12.e234322.6","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1007\/s10633-014-9466-6","article-title":"Diagnostic value of visual evoked potentials for clinical diagnosis of multiple sclerosis","volume":"130","author":"Chirapapaisan","year":"2015","journal-title":"Doc Ophthalmol"},{"key":"2025082623163004000_13.12.e234322.7","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1111\/nyas.13503","article-title":"The association of British neurologists' myasthenia gravis guidelines","volume":"1412","author":"Sussman","year":"2018","journal-title":"Ann N Y Acad Sci"},{"key":"2025082623163004000_13.12.e234322.8","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1016\/j.ajoc.2018.09.008","article-title":"Bilateral pseudo-internuclear ophthalmoplegia in a patient with myasthenia gravis","volume":"12","author":"McClard","year":"2018","journal-title":"Am J Ophthalmol Case Rep"},{"key":"2025082623163004000_13.12.e234322.9","doi-asserted-by":"publisher","DOI":"10.1136\/practneurol-2016-001428"},{"key":"2025082623163004000_13.12.e234322.10","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.62.5.714"},{"key":"2025082623163004000_13.12.e234322.11","first-page":"116","article-title":"Bilateral internuclear ophthalmoplegia in a patient with Wernicke's encephalopathy","volume":"12","author":"De La Paz","year":"1992","journal-title":"J Clin Neuroophthalmol"},{"key":"2025082623163004000_13.12.e234322.12","doi-asserted-by":"crossref","unstructured":"Kaufman DM , Milstein MJ . 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