{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T05:49:46Z","timestamp":1768456186858,"version":"3.49.0"},"reference-count":9,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,9,8]],"date-time":"2023-09-08T00:00:00Z","timestamp":1694131200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,9,8]],"date-time":"2023-09-08T00:00:00Z","timestamp":1694131200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Case Reports"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Myasthenia gravis is an autoimmune condition affecting the neuromuscular junction and causing muscle weakness along with fatigue (myasthenia). When the clinical manifestations of myasthenia gravis are isolated to the eye muscles, only causing weak eye movements, it is referred to as ocular myasthenia gravis, which can mimic a 1 and \u00bd syndrome.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>An African-American female in her fifties with past medical history of hypertension presented to our outpatient clinic with complaints of blurred vision for two\u00a0weeks. Her symptoms were associated with facial discomfort and a generalized headache. On physical examination upon her initial presentation, there was demonstratable swelling of the left upper eyelid with drooping. Her extraocular movements revealed defects with the abduction and adduction of the right eye, and the left eye would not adduct, although the outward movement was normal. The left eye failed to lift\/elevate completely when looking upwards, a pseudo 1 and \u00bd syndrome. A positive Cogan lid twitch was also noticed. Imaging of the brain and orbit ruled out central causes. Diagnosis of ocular myasthenia gravis was made in accordance with positive anti-acetylcholine receptor antibodies. With 120\u00a0mg pyridostigmine oral dose, the patient experienced improvement subjectively and objectively, and the patient was discharged on oral pyridostigmine and prednisone. Six months later, with prednisone having been tapered off, the patient developed a myasthenic crisis and was treated with plasmapheresis and intravenous immunoglobulins. After recovering from the myasthenic crisis, efgartigimod infusions were instituted, which helped our patient restore normal life.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Our patient who presented with \u201cblurred vision\u201d was discovered to have binocular diplopia due to significant dysconjugate eye movements. After diligently ruling out central etiologies, we concluded that\u00a0her presentation was due to a peripheral etiology. Her serologies and her presentation helped confirm a diagnosis of ocular myasthenia gravis. Also, as in most cases, our patient also progressed to develop generalized myasthenia gravis while on pyridostigmine. Efgartigimod infusions instituted after our patient recovered from a myasthenic crisis have helped her restore a normal life.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13256-023-04089-4","type":"journal-article","created":{"date-parts":[[2023,9,8]],"date-time":"2023-09-08T00:02:14Z","timestamp":1694131334000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Diplopia in a patient presenting with \u201cblurred vision\u201d: a case report"],"prefix":"10.1186","volume":"17","author":[{"given":"Anil","family":"Harrison","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Onkar","family":"Mudhar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Yoo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mayank","family":"Rampal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,9,8]]},"reference":[{"key":"4089_CR1","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1016\/j.ncl.2018.01.003","volume":"36","author":"M Al-Haidar","year":"2018","unstructured":"Al-Haidar M, Benatar M, Kaminski HJ. Ocular myasthenia. Neurol Clin. 2018;36:241.","journal-title":"Neurol Clin"},{"key":"4089_CR2","doi-asserted-by":"publisher","first-page":"2294","DOI":"10.1056\/NEJMra1114525","volume":"366","author":"N Yuki","year":"2012","unstructured":"Yuki N, Hartung HP. Guillain\u2013Barr\u00e9 syndrome. N Engl J Med. 2012;366:2294.","journal-title":"N Engl J Med"},{"key":"4089_CR3","doi-asserted-by":"publisher","first-page":"111","DOI":"10.3109\/01658107.2013.792356","volume":"37","author":"B Kaymakamzade","year":"2013","unstructured":"Kaymakamzade B, Selcuk F, Koysuren A, et al. Pupillary involvement in Miller Fisher syndrome. Neuro-Ophthalmology. 2013;37:111.","journal-title":"Neuro-Ophthalmology"},{"key":"4089_CR4","doi-asserted-by":"publisher","first-page":"1911","DOI":"10.1212\/WNL.43.10.1911","volume":"43","author":"A Chiba","year":"1993","unstructured":"Chiba A, Kusunoki S, Obata H, et al. Serum anti-GQ1b IgG antibody is associated with ophthalmoplegia in Miller Fisher syndrome and Guillain-Barr\u00e9 syndrome: clinical and immunohistochemical studies. Neurology. 1993;43:1911.","journal-title":"Neurology"},{"key":"4089_CR5","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1016\/S0140-6736(97)12308-X","volume":"352","author":"AF Hahn","year":"1998","unstructured":"Hahn AF. Guillain\u2013Barr\u00e9 syndrome. Lancet. 1998;352:635.","journal-title":"Lancet"},{"key":"4089_CR6","doi-asserted-by":"publisher","first-page":"1282","DOI":"10.1016\/S0161-6420(99)00709-5","volume":"106","author":"KC Golnik","year":"1999","unstructured":"Golnik KC, Pena R, Lee AG, Eggenberger ER. An ice test for the diagnosis of myasthenia gravis. Ophthalmology. 1999;106:1282.","journal-title":"Ophthalmology"},{"key":"4089_CR7","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1212\/WNL.0000000000011124","volume":"96","author":"P Narayanaswami","year":"2021","unstructured":"Narayanaswami P, Sanders DB, Wolfe G, et al. International consensus guidance for management of myasthenia gravis: 2020 update. Neurology. 2021;96:114.","journal-title":"Neurology"},{"key":"4089_CR8","doi-asserted-by":"publisher","first-page":"1079","DOI":"10.1212\/WNL.0000000000007605","volume":"92","author":"AC Guidon","year":"2019","unstructured":"Guidon AC, Juel VC. Efgartigimod: a novel antibody depletion therapy in myasthenia gravis. Neurology. 2019;92:1079.","journal-title":"Neurology"},{"key":"4089_CR9","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1136\/jnnp.48.4.332","volume":"48","author":"F Schumm","year":"1985","unstructured":"Schumm F, Wieth\u00f6lter H, Fateh-Moghadam A, Dichgans J. Thymectomy in myasthenia with pure ocular symptoms. J Neurol Neurosurg Psychiatry. 1985;48:332.","journal-title":"J Neurol Neurosurg Psychiatry"}],"container-title":["Journal of Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-023-04089-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13256-023-04089-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-023-04089-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,19]],"date-time":"2023-11-19T14:29:45Z","timestamp":1700404185000},"score":1,"resource":{"primary":{"URL":"https:\/\/jmedicalcasereports.biomedcentral.com\/articles\/10.1186\/s13256-023-04089-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,8]]},"references-count":9,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["4089"],"URL":"https:\/\/doi.org\/10.1186\/s13256-023-04089-4","relation":{},"ISSN":["1752-1947"],"issn-type":[{"value":"1752-1947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,8]]},"assertion":[{"value":"30 May 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 July 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 September 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethics approval is not required for this type of study. Written consent to participate in this study was obtained from the patient.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that there is no competing interest to be reported.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"402"}}