A Case of Myasthenia Gravis Presenting with Pseudo Bilateral 6th Cranial Nerve Palsy

N ormal binocular vision relies on the proper functioning of the coordination between the eyes, eye muscles, and neural structures.Additionally, it requires a complex process that ensures the parallel movement of the eyes and the integrated processing of visual information by the brain.Diplopia may reflect dysfunction at any point within this dynamic system and can sometimes indicate a significant local or systemic disease.The initial step in evaluating diplopia is to determine whether the double vision is monocular (with one eye) or binocular (with two eyes).The next step is to investigate which cranial nerves or eye muscles are affected and at which level the problem lies within the neurological axis. [1]me patients may not be aware of their double vision; instead, they may report symptoms such as blurred vision, ghost images, confusion, eye fatigue, or dizziness.When diplopia is detected, the two images may be horizontal, vertical, or diagonal.Diplopia can be present equally in all directions of gaze, or it may vary depending on a specific direction. [2] this case, the findings of diplopia developed as a result of myasthenia gravis, mimicking bilateral sixth cranial nerve palsy.Myasthenia gravis is an autoimmune neuromuscular junction disease caused by autoantibodies against acetylcholine receptors.This condition primarily manifests as weakness in skeletal muscles and typically presents initially with ocular symptoms such as ptosis and diplopia.Myasthenia gravis (MG) is an autoimmune disease of the neuromuscular junction caused by autoantibodies to acetylcholine receptor antibodies (AchRs).Patients with myasthenia gravis (MG) usually present with diffuse muscle weakness.Myasthenic weakness typically affects extraocular, bulbar, or proximal limb muscles.Clinical manifestations often begin in the eye muscles and are characterized by ptosis.When MG is isolated to ocular symptoms only, it is referred to as ocular myasthenia gravis (OMG).OMG can also present atypically, mimicking isolated cranial nerve palsies.A 21-year-old male patient with no significant medical history presented to the emergency department with complaints of diplopia, blurred vision, and headache.Neurological examination revealed bilateral outward gaze limitation.The patient, who had no history of chronic disease or regular medication use and had no special features in his family history, was diagnosed with myasthenia gravis after extensive tests.This case highlights that myasthenia gravis in young patients may present with atypical symptoms, deviating from the traditional manifestations, thus providing a valuable educational contribution to clinical practice.