Juvenile myasthenia gravis usually presents with ocular findings. Rarely, children may present with generalized weakness, sometimes with accompanying bulbar symptoms (dysphagia, facial weakness). However, presentation with isolated bulbar symptoms is extremely unusual. We present four consecutive cases of JMG presenting with predominant bulbar symptoms including voice nasality, dysarthria, and swallowing difficulty (even leading to significant weight loss). Our cases emphasize that primary care physicians should suspect neuromuscular disease such as JMG in children with bulbar symptoms and signs.
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