Revisiting two clinical techniques for diagnosing myasthenia gravis in Covid times: Pointing to semiology

As it has been evident in these times of the Covid-19 pandemic, the majority of health resources have been focused to the acute treatment, vaccination or research to this condition. By these reasons, some confirmatory complementary tests in many pathologies cannot be made or are postponed, including Myasthenia Gravis. Two clinical neurological signs useful for diagnosis of Myasthenia Gravis are revised: the “Curtain Sign” (also called paradoxical ptosis), that is evoked opening the more closed eye, which results in a dropping of the contralateral eyelid; and the Mary-Walker maneuver, which results from repetitive pronation-supination exercise under anaerobic conditions in one or both arms resulting in increasing of bilateral ptosis. The importance of a presumptive early diagnosis of Myasthenia Gravis is the early onset of specific treatment even when it’s impossible to carry out complementary studies like single-fiber electromyography, thoracic images, or specific immune studies. .