Acute hemiparesis with hemichorea and crossed hemiparesis : unusual presentation for myasthenia gravis

Myasthenia gravis is an autoimmune disease mediated by antibodies directed against the acetylcholine receptor. Patients typically present with weakness and fatiguability involving predominantly ocular and bulbar muscles. We describe 2 patients with acute weakness, one with a left hemiparetic pattern and chorea, and the other with crossed left hemiparesis and right facial weakness. More typical features of generalised myasthenia developed with time and both had thymic follicular hyperplasia on thymic histopathology. Clinical improvement occurred in both following thymectomy and immunosuppression. These cases exemplify the fact that markedly asymmetric limb weakness can be an early feature of generalised myasthenia gravis.