Myasthenia gravis is associated with painless weakness which is worse after exertion with deterioration during stress, infection or trauma.
Tendon reflexes are normal. It is an autoimmune disease associated with acetylcholine receptor and, rarely, anti-striated muscle antibodies.
Younger (<45 years), predominantly female patients may have a thymoma which, if resected, may provide remission.
Severe weakness may be the result of a myasthenic or cholinergic (e.g. sweating, salivation, lacrimation, colic, fasciculation, confusion, ataxia, small pupils, bradycardia, hypertension, seizures) crisis.
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