A 33-year-old female complains of episodes of weakness of the left side of the face.Drooping of the left eyelid and weakness of the jaw muscle develops gradually throughout the day,and it is worse at night than the morning.The patient has a medical-surgical history of cholecystectomy at age 30.Otherwise,patient has no history of illness and takes no medications.Denies use of tobacco or alcohol.On physical examination,vital signs are T 98 degrees,18 resps/min,pulse 66,and BP 110/60.Ptosis of the left eyelid is noted.Vision: 20/20 os,20/20 od,and 20/20 ou.Heart: regular rate and rhythm,no murmurs.Lungs are clear to auscultation.Abdomen is non-tender with no organomegaly.Extremities: Skin is pink,cool to touch,and intact bilaterally.Left and right quadriceps muscle strength 5/5.DTRs left and right + 2/4.No clonus.Negative Homan's and Babinski's sign.Sensation to pinprick and cotton ball intact in extremities and equal bilaterally.Dorsalis pedis pulses +1/4 bilaterally.Eyelids: left-sided ptosis.No facial droop.Left and right cheek sensation to pinprick and cotton ball intact.Masseter muscle: 2/5 left versus 5/5 on right.EOMs intact.Gag reflex: uvula midline gag intact.Shrug and sternocleidomastoid muscle strength 5/5 bilaterally.Tongue: midline and strength 5/5 bilaterally.The following disorder(s)should be considered in the diagnosis:

Question

Quizplus · Accepted Answer

The patient's symptoms of weakness on one side of the face that worsen throughout the day and improve with rest, along with the ptosis of the left eyelid and weakness of the jaw muscle, suggest a neuromuscular disorder such as myasthenia gravis. The absence of other neurological symptoms and history of cholecystectomy make a stroke or multiple sclerosis less likely. Bell's palsy can present with similar symptoms, but it typically has a sudden onset and is not usually associated with worsening throughout the day.

A 33-Year-Old Female Complains of Episodes of Weakness of the Left