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Fatigue test - Ocular Myasthenia GRAVIS
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Dr M.Nirumal Khumar(Neuro nerd) on Instagram: "Ice pack test in myasthenia gravis So in a pt with ptosis with not much of a limb weakness(ocular myasthenia), ice pack test is extremely useful in differentiating it from other causes of ptosis. Procedure - applying ice pack on the ptotic eye for 3-5 mins, causes increase in palpebral fissure size by 2mm and eventual improvement in ptosis.. Mechanism proposed- cooling inhibits acetylcholinesterase hence improved neuromuscular transmission Pitfalls-
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