Myasthenia Gravis Ptosis Ice Test

The ice pack test is positive in most patients who have ptosis caused by myasthenia gravis sensitivity is 77 100 and specificity is 88 100 implying a 0 12 chance that the result will also be positive in patients with non myasthenic ptosis.

Myasthenia gravis ptosis ice test. A clinical diagnosis of oculobulbar myasthenia gravis was suspected and on this basis a bedside ice test was performed. This is also a simple diagnostic test that can be done in the clinic. Myasthenia gravis was suspected and an ice pack test was performed with an instant cold pack over the left. A patient with symptoms of a myasthenic crisis was successfully diagnosed with myasthenia gravis mg using an approach called the ice pack test a case study reports.

To compare the ice test with tensilon test in sub jects with myasthenic and nonmyasthenic. The ice test is useful for ptosis. A positive test is the improvement of ptosis by 2mm or more. B immediately after 2 minute application of ice ptosis in the left eye significantly improved with a fissure change of 2 5 mm.

Symptomatic response to acetylcholinesterase medication may be equivocal and acetylcholine receptor achr auto antibodies may be absent in up to 30 of those with symptoms restricted. Except for this finding further investigations and treatment provided no other evidence of mg in their case making diagnosis uncertain. This transient improvement in ptosis is due to the cold decreasing the acetylcholinesterase break down of acetylcholine at the neuromuscular junction. Ice pack test in myasthenia gravis almeida et al.

Neurologic examination revealed ptosis of the left eye after a sustained upward gaze. 40 of patients have extra ocular muscle involvement at onset and the disease remains confined to the eyes in 16 of patients. Diagnostic tests to establish the diagnosis of mg as the cause of ptosis include serum acetylcholine receptor antibody levels electromyography emg the tensilon test the sleep test the rest test and the ice test. An ice pack is applied to the affected upper eyelid for 2 5 minutes.

Establishing the diagnosis of isolated ocular myasthenia is sometimes difficult. A asymmetric ptosis was present in both eyes prior to the ice test. It is highly sensitive and specific for mg. Myasthenia gravis often presents with ocular features most usually diplopia and ptosis.

Test on eye movements. The study ice pack test an useful bedside test to diagnose myasthenia gravis was published in qjm. Prior to the test the patient demonstrated a marked ptosis more prominent on the right figure 1a. An international journal of medicine.

A patient with bilateral ptosis in myasthenia gravis showing inconsistent results of the ice test performed on separate days in the right eye. This involved holding ice packs over the patient s closed eyes for 1 min and monitoring for resolution of ptosis.