Myasthenia Gravis Ptosis Ice Test

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. The ice test is useful for ptosis. Establishing the diagnosis of isolated ocular myasthenia is sometimes difficult.

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Diagnosing Myasthenia Gravis With An Ice Pack Nejm

Plos One Diagnostic Value Of Repeated Ice Tests In The Evaluation

Ice Pack Test In The Diagnosis Of Myasthenia Gravis

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Myasthenia Gravis Teaching Dr M D Mohire Kolhapur Maharashtra

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Myasthenia gravis often presents with ocular features most usually diplopia and ptosis.

Myasthenia gravis ptosis ice test. An ice pack is applied to the affected upper eyelid for 2 5 minutes. Prior to the test the patient demonstrated a marked ptosis more prominent on the right figure 1a. 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. Test on eye movements.

This involved holding ice packs over the patient s closed eyes for 1 min and monitoring for resolution of ptosis. Neurologic examination revealed ptosis of the left eye after a sustained upward gaze. Myasthenia gravis mg is an autoimmune disorder that often is seen with ptosis. A clinical diagnosis of oculobulbar myasthenia gravis was suspected and on this basis a bedside ice test was performed.

Myasthenia gravis was suspected and an ice pack test was performed with an instant cold pack over the left. The study ice pack test an useful bedside test to diagnose myasthenia gravis was published in qjm. 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.

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. Ice pack test in myasthenia gravis almeida et al.

To compare the ice test with tensilon test in sub jects with myasthenic and nonmyasthenic. 40 of patients have extra ocular muscle involvement at onset and the disease remains confined to the eyes in 16 of patients. It is highly sensitive and specific for mg. 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.

This is also a simple diagnostic test that can be done in the clinic. A asymmetric ptosis was present in both eyes prior to the ice test. This transient improvement in ptosis is due to the cold decreasing the acetylcholinesterase break down of acetylcholine at the neuromuscular junction. 1 2 3 4 5 6 7 8.

Abstract there are many tests for diagnosis of myasthenia gravis including tensilon test and ice test. A positive test is the improvement of ptosis by 2mm or more.