{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T07:10:17Z","timestamp":1756365017077,"version":"3.44.0"},"reference-count":8,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,6,5]]},"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:p>Numerous articles in the literature have reported cases of Parkinson\u2019s disease and myasthenia gravis (MG) occurring concurrently in the same patient. Here, we present a female patient in her late 60s diagnosed with ocular MG due to right eye ptosis and diplopia and treated with oral neostigmine. However, her right pupil was 5 mm in size and unresponsive to light, a finding atypical for MG. Further laboratory investigations for MG revealed negative results. On further physical examination, we noted mild rigidity, slight bradykinesia and slight tremors, raising the suspicion of early parkinsonism. A 99mTc-TRODAT Brain SPECT\/MRI hybrid fusion study revealed features suggestive of early parkinsonism. Consequently, she was managed appropriately for parkinsonism. This case represents a unique presentation of early parkinsonism with ocular features, highlighting the importance of thorough differential diagnosis in complex presentations.<\/jats:p>","DOI":"10.1136\/bcr-2025-266371","type":"journal-article","created":{"date-parts":[[2025,6,15]],"date-time":"2025-06-15T18:50:17Z","timestamp":1750013417000},"page":"e266371","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Early parkinsonism masquerading as ocular myasthenia gravis"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-3835-680X","authenticated-orcid":false,"given":"Goutham","family":"Rajasekar","sequence":"first","affiliation":[{"name":"Ophthalmology, JIPMER, Puducherry, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4396-825X","authenticated-orcid":false,"given":"Karthikeyan","family":"Mahalingam","sequence":"additional","affiliation":[{"name":"Ophthalmology, JIPMER, Puducherry, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nirupama","family":"Kasturi","sequence":"additional","affiliation":[{"name":"Ophthalmology, JIPMER, Puducherry, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kumaradharshini","family":"Maruthasalam","sequence":"additional","affiliation":[{"name":"Ophthalmology, JIPMER, Puducherry, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,6,15]]},"reference":[{"key":"2025082723550531000_18.6.e266371.1","doi-asserted-by":"publisher","DOI":"10.1177\/1941874414522498"},{"key":"2025082723550531000_18.6.e266371.2","doi-asserted-by":"crossref","DOI":"10.3390\/medicina56010005","article-title":"Patients with Parkinson\u2019s Disease and Myasthenia Gravis-A Report of Three New Cases and Review of the Literature","volume":"56","author":"Odajiu","year":"2019","journal-title":"Medicina (Kaunas)"},{"key":"2025082723550531000_18.6.e266371.3","doi-asserted-by":"crossref","DOI":"10.3389\/fneur.2023.1303434","article-title":"Parkinson\u2019s disease and comorbid myasthenia gravis: a case report and literature review","volume":"14","author":"Zhang","year":"2023","journal-title":"Front Neurol"},{"key":"2025082723550531000_18.6.e266371.4","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/j.parkreldis.2016.04.005","article-title":"Is it just a coincidence? Three new cases of Myasthenia Gravis associated with Parkinson\u2019s disease","volume":"28","author":"Sciacca","year":"2016","journal-title":"Parkinsonism Relat Disord"},{"key":"2025082723550531000_18.6.e266371.5","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.parkreldis.2021.06.016","article-title":"Coincident parkinsonism and myasthenia gravis: A case series","volume":"89","author":"Alshaikh","year":"2021","journal-title":"Parkinsonism & Related Disorders"},{"key":"2025082723550531000_18.6.e266371.6","unstructured":"Mao Z , Nie Q , Li Z , et al . Coexistence of Parkinson\u2019s disease and myasthenia gravis: disease characteristics and confusion. Mov Disord 2022;37."},{"key":"2025082723550531000_18.6.e266371.7","doi-asserted-by":"crossref","first-page":"832","DOI":"10.1212\/WNL.37.5.832","article-title":"Parkinson\u2019s disease and myasthenia gravis: adverse effect of trihexyphenidyl on neuromuscular transmission","volume":"37","author":"Ueno","year":"1987","journal-title":"Neurology (ECronicon)"},{"key":"2025082723550531000_18.6.e266371.8","doi-asserted-by":"publisher","DOI":"10.1002\/mds.20083"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-266371","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T06:55:15Z","timestamp":1756364115000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-266371"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6]]},"references-count":8,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6,15]]},"published-print":{"date-parts":[[2025,6]]}},"alternative-id":["10.1136\/bcr-2025-266371"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-266371","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2025,6]]}}}