Abstract

In the past, at Association of British Neurologists’ dinners, I accepted that I was usually the only neurologist in Highland evening dress, but to that idiosyncrasy I can now add the less pleasurable attribute of a malignant thymoma and myasthenia gravis.

Well how did it all begin? With a cough, a dry, brief, non-irritating cough, which started as far back as 1993 and as we will see disappeared after surgery. Around the same time I began to accumulate crumbs in the vestibule of my mouth, external to the teeth and inside the cheek, easier to extract digitally than with my tongue and worse on the left. Orofacial surgeons do describe some sort of rare focal facial muscular weakness; perhaps that was it, I thought! I used to dictate three medicolegal reports back-to-back and after filling a 1-hour tape, on occasion from 1996 onwards noted that I found it easier to