E-Pearl of the Week: Ice Pack Test

October 25, 2011


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October 10, 2011

Ice Pack Test

The ice pack test is a quick, inexpensive, and simple bedside test to aid in the diagnosis of myasthenia gravis. For a patient with ptosis and diplopia, the examiner applies a covered ice pack to the eyes for 2-5 minutes and if positive, there is improvement of either one or both symptoms. The proposed mechanism is that cooling of the skeletal muscle fibers inhibits the activity of acetylcholinesterases. This test has a reported sensitivity of 76.9% and specificity of 98.3%.


  1. Chatzistefanou KI, Kouris T, Iliakis E, et al. The ice pack test in the differential diagnosis of myasthenic diplopia. Ophthalmology 2009; 116:2236–2243.
  2. Ricker K, Hertel G, Stodieck S. Influence of temperature on neuromuscular transmission in myasthenia gravis. J Neurol 1977; 216:273–282.

Submitted by: Dimitrios A. Nacopoulos, MD and Seby John, MD, Neurology Residents, Cleveland Clinic. Cleveland, Ohio

Disclosures:Drs. Nacopoulos & Seby report no disclosures.

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