Four consecutive pictures of a patient in 1 hour. Diagnosis?

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Dx :- Faucal diphtheria, caused airway obstruction. It's mostly due to mitis variety. D / D :- Tetanus.

Risus sardonicus or rictus grin is a highly characteristic, abnormal, sustained spasm of the facial muscles that appears to produce grinning. It is most often observed as a sign of tetanus. It can also be caused by poisoning with strychnine, or in Wilson's disease.

How are you explaining the bilateral facial palsy with this theory?
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Despite the best answer being selected as risus sardonicus, please do note everyone who answered the pictures that the patient indeed came with myasthenic crisis. This was the neostigmine test done on stabilisation. He's been started on pyridostigmine and is doing well

Sir! Agreed your diagnosis.. but how to explain your serial changes in eyes in these serial pictures. First eyes eyes are closed then after giving neostigmine upper. eyelids paralyzed.. please explain..
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Dr Saumya Mittal sir please give your final dx. and given t/t. Also now pt. condition.

It's a case if MG
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risus sardonicus due to strychnine poisoning dd tetanus

Tetanus,lock jaw with rhisus Sardonicus

Y the bl facial weakness
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Tetanus Agree with Dr Parminder Singh

Thanks sir.
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Risus sardonicus due to tetanus.

Y the bl facial weakness
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Tetanus ( Rhisus sardonicus )

Response to neostigmine test

Sir muscle weakness is not appreciable from the photo. Is there such a history?
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