Signs and Symptoms of Myasthenia Gravis

  • Drooping eyelid (Can be one or both eyes)
  • Drooping or tired facial expression. The lips can have an appearance similar to that of a person who has had a stroke or Bells Palsy (It is important to have these ruled out if they are suspected)
  • Difficulty raising eyebrows, smiling or showing an animated expression.
  • Double vision (Can be horizontal, vertical or stacked)
  • Blurry vision
  • Generalized fatigue
  • Difficulty clearing secretions
  • Weakness in the face, jaw, throat, tongue, neck, arms, legs and hands
  • Difficulty chewing and swallowing (Particularly tough, fibrous foods and thin liquids like broths and beverages. It is not uncommon to see regurgitation into the nasal passage after drinking or trying to swallow saliva)
  • Mild muscular twitching
  • Drooling
  • Slurred, soft, raspy or nasal speech
  • Shortness of breath, having to use shoulders and labor at getting a deeper breath, more shallow breathing and weakness of the inspiratory muscles (accessory muscles and diaphragm) that affect the ability to breathe. May worsen after activity, later in the day or laying down. If your breathing is worsening or especially noticeable laying down, seek emergency help.
  • Cognitive fog or difficulty with concentration, short term memory and linguistic skills. This particular set of symptoms is not always relegated to Myasthenia Gravis, however, changing research shows a connection in the decline of cognitive abilities in MG. They are not sure if medication, poor sleep patterns or the disease itself is the culprit.
  • Changing or diminished taste buds
  • Difficulty with grip/holding objects of any weight. Some struggle to open their hand with the palm fully flat and extended
  • Pain is noted anecdotally and is often described as burning or a low systemic ache similar to an overworked muscle in the gym. Inadequate and anemic studies do not correlate pain with Myasthenia Gravis, but there is a growing movement clinically in support of pain associated with Myasthenia Gravis. More studies need to be done on this subject. Cited pain is considered a by-product of over-exerted, weakened muscles and additional causes should be ruled out to ensure there is not an additional underlying cause.
  • Hearing loss is another rarely discussed feature of Myasthenia Gravis. There is increasing evidence of a connection between hearing function and MG. Studies suggest that acetylcholine (AChR) receptors on outer hair cells play a central role in hearing diminishment. 
  • Urinary incontinence is fairly uncommon but can be associated with the disease. It may also be attributed to Lambert-Eaton Myasthenic Syndrome (LEMS) which behaves similarly to MG but is a pre-synaptic disease whereas MG is a post-synaptic disease.  
  • Generally speaking, symptoms tend to worsen as the day progresses, with stress, heat, repetitive activity, additional illness like thyroid disease, menses and incorrect or contraindicated medications.

Myasthenic crisis is a serious and life threatening form of Myasthenia Gravis involving severe bulbar weakness (swallowing, speaking, chewing) and flaccidity (weakness) of the inspiratory muscles responsible for diaphragm contraction and secondary lung function. It requires emergency medical intervention and appropriate treatment. Early diagnosis and prompt medical management are crucial to increasing stable outcomes. Warning signs of a Myasthenic crisis are: 

  • Inability to lay flat without feeling short of breath or gasping for air
  • Frequently waking up feeling short of breath
  • Unable to speak without needing to pause frequently
  • Weak neck
  • Difficutly swallowing saliva
  • Drooling
  • Weak cough or inability to take a sniff of air
  • Rapid, shallow breathing
  • Regurgitation of liquids or saliva into the nose
  • Soft, nasal, raspy or slurred speech
  • Increased systemic weakness
  • Unable to count out loud past 20 after a full breath of air (known as the single breath test)
  • Rib muscles pulling in during inhalation (paradoxical breathing)
  • Feeling agitated or restless (hypoxia)
  • Feeling sleepy in spite of struggle to breathe (hypercapnia)
  • General feeling that something is wrong
  • Any sudden changes or acute worsening
  • Tachycardia and hypertension may be present

Please do not wait to get emergency treatment. If you suspect crisis and are not sure what to do, please err on the side of caution and seek emergency help. If you are needing advocacy assistance or have questions, please reach out to our compassionate care team at 407-680-6677.