History A 32-year-old woman has presented to the emergency department with increasing difficulty in swallowing and difficulty in breathing. She is also unable to lift her arms and her head keeps drooping. These symptoms appeared after a recent chest infection. Last year she had visited her GP because of double vision that worsened with reading and with intermittent weakness. She also noted difficulty in talking after prolonged speech. However, symptoms were mild and occasional only and no treatment was required.
She has no medical history, is not on medications and is generally fit and well. Examination This woman looks fatigued and has droopy eyelids. She breathes quickly and shallowly. A neurological examination reveals proximal muscle weakness and bilateral mild ptosis but no muscle wasting or abnormal reflexes. The rest of the cardiovascular, respiratory and abdominal examination is…
