BOF: 2.29
A 65-year-old male presents with a history of difficulty
in walking. On examination there is weakness of the proximal muscles of the
lower limbs. The tendon reflexes are depressed but no other neurological
deficit is detected.
On further questioning the patient also admits to having
a dry mouth, constipation and impotence. He has no diplopia.
In this patient the investigation that is most specific
for the condition that he suffers from is:
a)
Anti acetylcholine receptor antibodies (Anti AChR)
b)
Anti Muscle Specific Kinase antibodies (Anti MuSK)
c)
Anti voltage gated calcium channel antibodies
d)
Tensilon test
e)
Chest X-ray
Answer:
c)
The history of proximal muscle weakness mainly affecting
the lower limbs, depressed tendon reflexes and absence of diplopia together
with autonomic symptoms suggests that the patient has the Lambert-Eaton
myasthenic syndrome.
In this syndrome antibodies against voltage gated calcium
channels are present in the serum of most patients and these antibodies are
highly specific.
