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Juvenile myasthenia gravis mimicking recurrent VI nerve palsy of childhood
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  1. M R Vishwanath1,
  2. K K Nischal1,
  3. L J Carr2
  1. 1Department of Ophthalmology, Great Ormond Street Hospital, and Visual Sciences Unit, Institute of Child Health, London, UK
  2. 2Department of Neurology, Great Ormond Street Hospital, London, UK
  1. Correspondence to:
    Mr K K Nischal
    Consultant Ophthalmologist, Department of Ophthalmology, Great Ormond Street Hospital, Great Ormond Street, London WC1N 3CH, UK; kknbtinternet.com

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A 5 year old Asian boy presented to the paediatrician with diplopia following ear ache. Isolated VI nerve palsy was suspected. Full blood count, ESR, magnetic resonance imaging (MRI), and ENT examination were normal. He recovered within a week, but subsequently suffered six episodes of transient convergent squint with abduction deficit. He was referred to our neurologist for further opinion.

His developmental milestones, family history, and ocular and general examination as well as investigations were normal apart from vitiligo around the lids. At subsequent consultation, a right convergent squint was noted but with …

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