Dr.G. NAGARAJU, N06563
Method:24 year old presented with h/o fall from height 2 months ago,after which he had periorbital edema of LE.On resolving he noticed drooping of left upper lid which was more towards evening.H/o diplopia was present.k/c/o rheumatic heart disease and treated for infective endocarditis.LE O/E-Vn 6/6, ptosis which was variable,constant 8PD hypotropia.Limitation of upgaze in primary position,abduction,adduction.FDT-s/o superior rectus palsy.Cover uncover test-ptosis partially got corrected(true+pseudoptosis).Signs-Cogans lid twitch sign,fatigue test,ice pack test positive.Results:Ach receptor antibody test-negative.RNS-normal.CT/MRI was normal.As Ice pack test was positive,diagnosis of OMG was made.Conclusion:Ach receptor antibodies positive in 30-70% ,RNS in 33% of pure OMG,so a negative test does not rule out OMG.Ice pack test has high specificity-98%,sensitivity-76% can be taken as basis for diagnosing OMG,starting the patient on treatment to prevent progression to generalised disease
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