A 64-year-old woman with
myasthenia gravis (MG) presented with isolated bulbar symptoms. Two years earlier, she had developed neck weakness,
diplopia, and ptosis and was diagnosed with MG. Extensive
thymectomy was performed, and she was treated with predonisolone (PSL). The neck weakness,
diplopia, and ptosis improved over a 2-year period. However,
dysphagia developed, and her voice took on a nasal tone that did not improve subjectively even after administration of 10 mg of
edrophonium chloride (EC). We then performed videofluorography (VF). After consumption of 10 ml of liquid
barium and 8 g of corned beef hash, she attempted to swallow, but the residue remained in the valleculae and the piriform fossa. After the EC injection, her
dysphagia on ingestion of corned beef hash improved; however, there was slight subjective improvement in swallowing. Drinking of liquid
barium resulted in some residue with slight improvement of
dysphagia.
After treatment with 70 mg of PSL for 4 weeks, VF showed improvement of
dysphagia. Thus, VF, particularly during consumption of solid food, with EC administration is helpful in evaluating bulbar symptoms in patients with MG.