#DiagnosticDilemma: what is your take on this case?
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A 51-year-old woman with a sudden decrease in the tone and texture of her voice for the past 15 days came to the neuro clinic. Her voice was very feeble but understandable, she noticed it was better when she woke up and gradually worsened throughout the day. She noticed a slight change in the texture of her voice in the early days and her symptom progressively aggravated in later days to the extent that she was not able to produce sound properly. There is no history of -coughing, choking, aspiration, any throat discomfort or habits. On physical and systemic examination, no abnormality was detected.

Neuro examination:

Her muscle power was intact: 15/15. She had no imbalance and was able to tandem on walking. An examination of her gag reflex and other cranial nerves revealed no abnormal reflexes. Deep tendon reflexes were intact. Her speech articulation was intact and revealed no scanning of speech. Speech production was adequate and non-painful; her tone was non-nasal but the intensity was low and slow. MRI Brain & Spine, Hematological investigations were normal. Chest CT-revealed a mass in the anterior mediastinum.

Which of the following conditions is commonly associated with this finding?

A. Laryngeal disorder
B. Parkinson's disease
C. Bulbar variant of motor neuron disease
D. Myasthenia Gravis

The answer to be disclosed shortly!
Dr. D●●●●i S●●h and 12 others like this2 shares
V●●●●●●●●h C
V●●●●●●●●h C General Medicine
Mar 8, 2019Like
Dr. H●●●●h P●●●l
Dr. H●●●●h P●●●l Internal Medicine
My thoughts favour Myesthenia gravis
Mar 10, 2019Like
Dr. K●●●●●a R●o T●●●●a
Dr. K●●●●●a R●o T●●●●a General Medicine
Mar 13, 2019Like