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A 23-year-old woman with near vision difficulty
Digital Journal of Ophthalmology 2007
Volume 13, Number 5
January 9, 2007
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H. Ozden Sener | Departments of Neurology and Ophthalmology, Ankara University School of Medicine
Mine H. Sorgun | Department of Neurology, Ankara University School of Medicine
Huban Atilla | Department of Ophthalmology, Ankara University School of Medicine
Canan Yucesan | Department of Neurology, Ankara University School of Medicine
Ancillary Testing
The ESR was 49mm/h. Blood leukocyte and platelet counts were 2700/uL and 196,00/uL, respectively. The hemoglobin level was 10.7g/dL. Vitamin B12, folate, and thyroid function tests were normal. Routine electromyography (EMG), repetitive nerve stimulation test, single fiber EMG, sympathetic skin response study, cranial magnetic resonance investigation, thoracic computerized tomogram (CT), routine cerebrospinal fluid examination and abdominal ultrasonogram were all normal. Gastric emptying was remarkably delayed.

Antibody testing:
Tests for brusellosis, HIV infection and syphilis were negative. Serum anti-HU, Anti-Ri, Anti-Yo and Collapsin response-mediator protein-5 (CRMP-5) IgGs by western blot were normal. Ach receptor (muscle) blocking antibody titer was 21% (normal:0-25%).

The following tests were abnormal: Ach receptor (muscle) binding antibody [2,44nmol/L (normal: IU 0.02 nmol/L)], striational antibody [1/122880 titer (normal: <1/60)], Ach receptor (muscle) modulating antibody [83% (normal: 0-20%)]. She was seropositive for ganglionic AChR antibody and GAD65 antibody.