Many newly discovered pathological and physiological variants of neuromuscular junction function have been identified. We report a case of a myasthenia gravis-like syndrome with onset of ptosis at age six years and eventual evaluation for peripheral weakness twenty years later. Subsequent muscle biopsy showed a previously unreported finding of perineurial cell ensheathement of the muscle fibers. We suggest that the ensheathement of the muscle cells by perineurial cells may alter the microenvironment interfering with neuromuscular transmission.

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microenvironment neuromuscular transmission perineurial cell ensheathement pathological and physiological variants of neuromuscular junction function

M L, Michaelis J A, King R W, Leech K W, Min R A, Brumback,.Perineurial cell ensheathement of muscle fibers: a new syndrome of fatigable muscle weakness mimicking myasthenia gravis.. 10 (2),79-84.

M L, Michaelis J A, King R W, Leech K W, Min R A, Brumback,"Perineurial cell ensheathement of muscle fibers: a new syndrome of fatigable muscle weakness mimicking myasthenia gravis." 10

M L, Michaelis J A, King R W, Leech K W, Min R A, Brumback,"Perineurial cell ensheathement of muscle fibers: a new syndrome of fatigable muscle weakness mimicking myasthenia gravis."