19th February 2024

A 32-year-old female presents to the acute medical unit with double vision

A 32-year-old female presents to the acute medical unit with double vision in all directions of vision. She also notes increased drooping of both eyelids that appear to vary in severity daily. Her husband has noted a change in the character of her voice, with her voice sounding softer with a nasal voice during the evenings and at night. She has also noted choking on her food with associated difficulty swallowing. She occasionally needed to use her hand to support her chin to keep her head upright.

Examination of her shoulder revealed loss of power on repeated movements. Bilateral tongue atrophy was noted. Bilateral diplopia was reproduced on sustained lateral gaze of her eyes. Neck muscle weakness was noted on examination.

Considering the underlying diagnosis, which of the following autoantibodies is MOST likely to be positive in this case?

Select the SINGLE most appropriate option from the list below. Select ONE option only.