adj.

しるし
目立つ、著しい。著明な。目星をつけられている。

関: conspicuous、conspicuously、dramatic、intense、manifest、markedly、notable、noteworthy、outstanding、profound、prominent、prominently、remarkable、salient、significant、striking

WordNet

singled out for notice or especially for a dire fate; "a marked man"
strongly marked; easily noticeable; "walked with a marked limp"; "a pronounced flavor of cinnamon" (同)pronounced
having or as if having an identifying mark or a mark as specified; often used in combination; "played with marked cards"; "a scar-marked face"; "well-marked roads"
reveal its presence or make an appearance; "the ghost manifests each year on the same day"
a customs document listing the contents put on a ship or plane
record in a ships manifest; "each passenger must be manifested"
showing intellectual penetration or emotional depth; "the differences are profound"; "a profound insight"; "a profound book"; "a profound mind"; "profound contempt"; "profound regret"
situated at or extending to great depth; too deep to have been sounded or plumbed; "the profound depths of the sea"; "the dark unfathomed caves of ocean"-Thomas Gray; "unplumbed depths of the sea"; "remote and unsounded caverns" (同)unfathomed, unplumbed, unsounded
coming from deep within one; "a profound sigh"
of the greatest intensity; complete; "a profound silence"; "a state of profound shock"
distinguished from others in excellence; "did outstanding work in human relations"; "an outstanding war record"
owed as a debt; "outstanding bills"; "the amount still owed"; "undischarged debts" (同)owing, undischarged
having a quality that thrusts itself into attention; "an outstanding fact of our time is that nations poisoned by anti semitism proved less fortunate in regard to their own freedom"; "a new theory is the most prominent feature of the book"; "salient traits"; "a spectacular rise in prices"; "a striking thing about Picadilly Circus is the statue of Eros in the center"; "a striking resemblance between parent and child" (同)prominent, salient, spectacular, striking
used of a singer or singing voice that is marked by power and expressiveness and a histrionic or theatrical style; "a dramatic tenor"; "a dramatic soprano"
sensational in appearance or thrilling in effect; "a dramatic sunset"; "a dramatic pause"; "a spectacular display of northern lights"; "it was a spectacular play"; "his striking good looks always created a sensation" (同)spectacular, striking
pertaining to or characteristic of drama; "dramatic arts"
suitable to or characteristic of drama; "a dramatic entrance in a swirling cape"; "a dramatic rescue at sea"
not having an identifying mark; "unmarked cards"; "an unmarked police car"
(of goods and merchandise) labeled with proprietary (and legally registered) identification guaranteeing exclusive use; "trademarked goods"
clearly indicated; "a well-marked route"
having yellow marks
make or leave a mark on; "the scouts marked the trail"; "ash marked the believers foreheads"
formerly the basic unit of money in Germany (同)German mark, Deutsche Mark, Deutschmark
the impression created by doing something unusual or extraordinary that people notice and remember; "it was in London that he made his mark"; "he left an indelible mark on the American theater"
a number or letter indicating quality (especially of a students performance); "she made good marks in algebra"; "grade A milk"; "what was your score on your homework?" (同)grade, score
a visible indication made on a surface; "some previous reader had covered the pages with dozens of marks"; "paw prints were everywhere" (同)print
a symbol of disgrace or infamy; "And the Lord set a mark upon Cain"--Genesis (同)stigma, brand, stain
a written or printed symbol (as for punctuation); "his answer was just a punctuation mark"
designate as if by a mark; "This sign marks the border"

PrepTutorEJDIC

印(記号)のついた / (物・行為などが)著しい,目立つ,明らかな / (嫌疑などの対象として)目星をつけられている
『明白な』,はっきりした(clear) / …‘を'『はっきり表す』(『示す』),表明する・(税関に提出するための船・飛行機の)積み荷目録;乗客名簿・宣言・声明書・檄文・特に，共産党宣言・政策綱領（イギリスの選挙で政党から公表されるもので，具体性を欠く選挙スローガンや公約と異なり，政策の数値目標，実施期限，財源などを明示する）
『深遠な』,深い洞察力をもった / 《名詞の前に用いて》《文》深い,深い所の / 心の底からの,深い / 『完全な』,全くの / (書物・学説などが)深みのある,難解な
『目立つ』,顕著な,傑出して / 残っている,未決の,未払いの
『劇の』,演劇の,劇に関する / 『劇的な』,感動的な,印象的な / 芝居がかりの
印(傷跡)のついていない / 注目されていない / 未評価の;未修正の,未添削の
あばたのある
〈C〉(…の表面についた)『跡』,汚れ,はん点《+『on』+『名』》 / 〈C〉『印』,記号,符号,標章 / 〈C〉《おもに英》(学業などの)『点数』,成績,評価,(…の)得点《+『in』(『for』)+『名』》 / 〈C〉(ある性質の)『徴候』,『特徴』,現れ,様相《+『of』+『名』》 / 〈C〉(思想・生活などに及ぼす)『影響』,感化《+『on』+『名』》 / 〈C〉(境界などの)位置を示すもの,指標,目印 / 〈C〉『的』,標的 / 〈C〉《the mark》水準,標準 / 〈U〉《文》著名,重要性;名声 / 〈C〉(軽べつ・もの笑いなどの)対象,的 / 〈U〉《通例M-》武器記号,…型 / 〈C〉スタートライン / (…で)…‘に'『印をつける』,跡をつける《+『名』++『with』+『名』》 / 〈物が〉…‘を'印となっている,‘を'示している / …‘を'印(記号など)で示す / 〈物・事柄などが〉…‘を'『特徴づける』,目立たせる / 〈答案など〉‘に'点(印)をつける / (…の候補に)…‘を'選び出す《+『名』+『out for』+『名』》 / …‘に'注意を払う,柱目する
マルク(ドイツノ貨幣単位;《略》『MK.』)

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/11/09 16:28:42」(JST)

wiki en

[Wiki en表示]

"Unmarked" redirects here. For undecorated law enforcement vehicles, see Police car#Functional types.

Markedness, a term which originated in linguistics, is the state of standing out as unusual or difficult in comparison to a more common or regular form. In a marked/unmarked relation, one term of an opposition is the broader, dominant one. The dominant default or minimum effort form is known as the 'unmarked' term and the other, secondary one is the 'marked' term. In other words, it is the characterization of a "normal" linguistic unit (i.e. the unmarked term) compared to the unit's possible "irregular" forms (i.e. the marked term). For example, in English, irregular verbs are marked, while regular verbs are unmarked in comparison.

In linguistics, markedness can apply, among others, phonological, grammatical, and semantic oppositions, defining them in terms of 'marked' and 'unmarked' oppositions like honest (unmarked) vs. dishonest (marked). Marking may be purely semantic, or may be realized as extra morphology. The term derives from the 'marking' of a grammatical role with a suffix or other element, but has been extended to situations where there is no morphological distinction.

In the social sciences more broadly, markedness is used to distinguish two meanings of the same term, where one is common usage (unmarked sense) and the other is specialized to a cultural context (marked sense).

Marked and unmarked word pairs[edit]

In terms of lexical opposites, marked form is a non-basic, often one with inflectional or derivational endings. Thus, a morphologically negative word form is marked as opposed to a positive one: happy/unhappy, honest/dishonest, fair/unfair, clean/unclean and so forth. Similarly, unaffixed masculine or singular forms are taken to be unmarked in contrast to affixed feminine or plural forms: lion/lioness, host/hostess, automobile/automobiles, child/children. An unmarked form is also a default form. For example, the unmarked lion can refer to a male or female, while lioness is marked because it can refer only to females.

The default nature allows unmarked lexical forms to be identified even when the opposites are not morphologically related. In the pairs old/young, big/little, happy/sad, clean/dirty, the first term of each pair is taken as unmarked because it occurs generally in questions. For example, English speakers typically ask how old (big, happy, clean) … something or someone is. To use the marked term presupposes youth, smallness, unhappiness, or dirtiness.

Background in the Prague School[edit]

While the idea of linguistic asymmetry predated the actual coining of the terms 'marked' and 'unmarked' the modern concept of markedness originated in the Prague School structuralism of Roman Jakobson and Nikolai Trubetzkoy as a means of characterizing binary oppositions.^[1] Both sound and meaning were analyzed into systems of binary distinctive features. Edwin Battistella said "Binarism suggests symmetry and equivalence in linguistic analysis; markedness adds the idea of hierarchy."^[2] Trubetzkoy and Jakobson analyzed phonological oppositions such as nasal versus non-nasal as defined as the presence versus the absence of nasality; the presence of the feature, nasality, was marked; its absence, non-nasality, was unmarked. For Jakobson and Trubetzkoy, binary phonological features formed part of a universal feature alphabet applicable to all languages. In his 1932 article "Structure of the Russian Verb", Jakobson extended the concept to grammatical meanings in which the marked element 'announces the existence of [some meaning] A' while the unmarked element 'does not announce the existence of A, i.e., does not state whether A is present or not'.^[3] Forty years later, Jakobson described language by saying that "every single constituent of a linguistic system is built on an opposition of two logical contradictories: the presence of an attribute ('markedness') in contraposition to its absence ('unmarkedness')."^[4]

In his 1941 Child Language, Aphasia, and Universals of Language, Jakobson also suggested that phonological markedness played a role in language acquisition and loss. Drawing on existing studies of acquisition and aphasia, Jakobson suggested a mirror image relationship determined by a universal feature hierarchy of marked and unmarked oppositions. Today many still see Jakobson's theory of phonological acquisition as identifying useful tendencies.^[5]

Jakobsonian tradition[edit]

The work of Cornelius van Schooneveld, Edna Andrews, Rodney Sangster, Yishai Tobin and others on 'semantic invariance' (different general meanings reflected in the contextual specific meanings of features) has further developed the semantic analysis of grammatical items in terms of marked and unmarked features. Other semiotically-oriented work has investigated the isomorphism of form and meaning with less emphasis on invariance, including the efforts of Henning Andersen, Michael Shapiro, and Edwin Battistella. Shapiro and Andrews have especially made connections between the semiotic of C. S. Peirce and markedness, treating it as "as species of interpretant" in Peirce's sign-object-interpretant triad.

Functional linguists such as Thomas Givon have suggested that markedness is related to cognitive complexity—"in terms of attention, mental effort or processing time".^[6] And linguistic 'naturalists' view markedness relations in terms of the ways in which extralinguistic principles of perceptibility and psychological efficiency determine what is natural in language. Linguist Willi Mayerthaler, for example, defines unmarked categories as those "in agreement with the typical attributes of the speaker".^[7]

Cultural markedness[edit]

Since a main component of markedness is the information content and information value of an element,^[8] some studies have taken markedness as an encoding of that which is unusual or informative, and this is reflected in formal probabilistic definitions of Markedness and Informedness (as chance-correct unidirectional components of the Matthews Correlation Coefficient corresponding to deltap and deltap'.^[9] Conceptual familiarity with cultural norms provided by familiar categories creates a ground against which marked categories provide a figure, opening the way for markedness to be applied to cultural and social categorization.

As early as the 1930s Jakobson had already suggested applying markedness to all oppositions, explicitly mentioning such pairs as life/death, liberty/bondage, sin/virtue, and holiday/working day. Linda Waugh extended this to oppositions like male/female, white/black, sighted/blind, hearing/deaf, heterosexual/homosexual, right/left, fertility/barrenness, clothed/nude, and spoken language/written language.^[10] Battistella expanded this with the demonstration of how cultures align markedness values to create cohesive symbol systems, illustrating with examples based on Joseph Needham's work.^[11] Other work has applied markedness to stylistics, music, myth.^[12]

Local markedness and markedness reversals[edit]

Markedness depends on context. What is more marked in some general contexts may be less marked in other local contexts. Thus, "ant" is less marked than "ants" on the morphological level, but on the semantic (and frequency) levels it may be more marked since ants are more often encountered many at once than one at a time. Often a more general markedness relation may be reversed in a particular context. Thus, voicelessness of consonants is typically unmarked. But between vowels or in the neighborhood of voiced consonants, voicing may be the expected or unmarked value.

Reversal is reflected in certain Frisian words' plural and singular forms:^[13] In Frisian, nouns with irregular singular-plural stem variations are undergoing regularization. Usually this means that the plural is reformed to be a regular form of the singular:

Old paradigm: "koal" (coal), "kwallen" (coals) → regularized forms: "Koal" (coal), "Koalen" (coals).

However, a number of words instead reform the singular by extending the form of the plural:

Old paradigm: "earm" (arm), "jermen" (arms) → regularized forms: "jerm" (arm), "jermen" (arms)

The common feature of the nouns that regularize the singular to match the plural is that they occur more often in pairs or groups than singly; they are said to be semantically (but not morphologically) locally unmarked in the plural.

Universals and frequency[edit]

Joseph Greenberg's 1966 book Language Universals was an influential application of markedness to typological linguistics and a break from the tradition of Jakobson and Trubetzkoy. Greenberg took frequency to be the primary determining factor of markedness in grammar and suggested that unmarked categories could be determined by "the frequency of association of things in the real world".

Greenberg also applied frequency cross-linguistically, suggesting that unmarked categories would be those that are unmarked in a wide number of languages. However, critics have argued that frequency is problematic because categories that are cross-linguistically infrequent may have a high distribution in a particular language.^[14]

More recently the insights related to frequency have been formalized as chance-corrected conditional probabilities, with Informedness (deltap') and Markedness (deltap) corresponding to the different directions of prediction in human association research (binary associations or distinctions) ^[15] and more generally (including features with more than two distinctions).^[9]

Universals have also been connected to implicational laws. This entails that a category is taken as marked if every language that has the marked category also has the unmarked one but not vice versa.

Diagnostics[edit]

Markedness has been extended and reshaped over the past century and reflects a range of loosely connected theoretical approaches. From emerging in the analysis of binary oppositions, it has become a global semiotic principle, a means of encoding naturalness and language universals, and a terminology for studying defaults and preferences in language acquisition. What connects various approaches is a concern for the evaluation of linguistic structure, though the details of how markedness is determined and what its implications and diagnostics are varies widely. Other approaches to universal markedness relations focus on functional economic and iconic motivations, tying recurring symmetries to properties of communication channels and communication events. Croft (1990), for example, notes that asymmetries among linguistic elements may be explainable in terms economy of form, in terms of iconism between the structure of language and conceptualization of the world.

Markedness in generative grammar[edit]

Markedness entered generative linguistic theory through Chomsky and Halle's The Sound Pattern of English. For Chomsky and Halle, phonological features went beyond a universal phonetic vocabulary to encompass an 'evaluation metric', a means of selecting the most highly-valued adequate grammar. In The Sound Pattern of English, the value of a grammar was the inverse of the number of features required in that grammar. However, Chomsky and Halle realized that their initial approach to phonological features made implausible rules and segment inventories as highly valued as natural ones. The unmarked value of a feature was cost-free with respect to the evaluation metric, while the marked feature values were counted by the metric. Segment inventories could also be evaluated according to the number of marked features. However, the use of phonological markedness as part of the evaluation metric was never able to fully account for the fact that some features are more likely than others or for the fact that phonological systems must have a certain minimal complexity and symmetry^[16]

In generative syntax, markedness as feature-evaluation did not receive the same attention that it did in phonology. Chomsky came to view unmarked properties as an innate preference structure based first in constraints and later in parameters of universal grammar. In their 1977 article 'Filters and Control', Chomsky and Howard Lasnik extended this to view markedness as part of a theory of 'core grammar':

We will assume that [Universal Grammar] in not an 'undifferentiated' system, but rather incorporates something analogous to a 'theory of markedness' Specifically, there is a theory of core grammar with highly restricted options, limited expressive power, and a few parameters. Systems that fall within core grammar constitute 'the unmarked case'; we may think of them as optimal in terms of the evaluation metric. An actual language is determined by fixing the parameters of core grammar and then adding rules or conditions, using much richer resources, ... These added properties of grammars we may think of as the syntactic analogue of irregular verbs.^[17]

A few years later Chomsky would describe it this way:

The distinction between core and periphery leaves us with three notions of markedness: core versus periphery, internal to the core, and internal to the periphery. The second has to do with the way parameters are set in the absence of evidence. As for the third, there are, no doubt, significant regularities even in departures from the core principles (for example, in irregular verb morphology in English), and it may be that peripheral constructions are related to the core in systematic ways, say by relaxing certain conditions of core grammar.^[18]

Some generative researchers have applied markedness to second-language acquisition theory, treating it as an inherent learning hierarchy which reflects the sequence in which constructions are acquired, the difficulty of acquiring certain constructions, and the transferability of rules across languages [REF NEEDED]. More recently, Optimality Theory approaches emerging in the 1990s have incorporated markedness in the ranking of constraints.^[19]

References[edit]

^ Andersen Henning "Markedness--The First 150 Years". In Markedness in Synchrony and Diachrony. Mouton de Gruyter, Berlin, 1989
^ Battistella, Edwin Markedness: The Evaluative Superstructure of Language. SUNY Press, 1990.
^ Jakobson, R 1932 "The Structure of the Russian Verb" reprinted in Russian and Slavic Grammar Studies, 1931-1981,Mouton,1984.
^ Jakobson, R Verbal Communication. Scientific American 227: 72-80, 1972
^ Battistella, Edwin, The Logic of Markedness. NY: Oxford Uniuversity Press, 1996,
^ Givôn Thomas Syntax: A Functionai-Typological Introduction,volume 2,John Benjamins, Amsterdam 1990.
^ Mayerthaler Willi Morphological Naturalness. Karoma, Ann Arbor,1988.
^ Battistella, Markedness, 1990.
^ ^a ^b Powers, David M W (2007/2011). "Evaluation: From Precision, Recall and F-Score to ROC, Informedness, Markedness & Correlation". Journal of Machine Learning Technologies 2 (1): 37–63.
^ Waugh, Linda Waugh, Marked and Unmarked: A Choice Between Unequals in Semiotic Structure. Semiotica 38: 299-318, 1982
^ Battistella, Edwin, Markedness, 1990, 188-189.
^ Myers-Scotton Carol (ed.) Codes and Consequences: Choosing Linguistic Varieties. Oxford, 1998; Hatten Robert Musical Meaning in Beethoven: Markedness, Correlation, and Interpretation. Indiana University Press, 1994; Liszka, James J. The Semiotic of Myth. Indiana University Press, 1989
^ Tiersma, Peter. "Local and General Markedness", Language, 1982.
^ Battistella, Edwin, The Logic of Markedness, 1996, 51.
^ Perruchet, P.; Peereman, R. (2004). "The exploitation of distributional information in syllable processing". J. Neurolinguistics 17: 97−119.
^ Kean, Mary-Louise, The Theory of Markedness in Generative Grammar Indiana University Linguistics Club, Bloomington, IN, 1980
^ Chomsky Noam and Howard Lasnik, Filters and Control. Linguistic Inquiry 8.3: 425-504 1977
^ Chomsky, Noam. Knowledge of Language: Its Nature, Origin and Use. Praeger,1986
^ see Archangeli 1997

Bibliography[edit]

Andersen Henning 1989 "Markedness--The First 150 Years", In Markedness in Synchrony and Diachrony. Mouton de Gruyter, Berlin.
Andrews Edna 1990 Markedness Theory: The Union of Asymmetry and Semiosis in Language, Duke University Press, Durham,NC.
Archangeli Diana 1997 "Optimality Theory: An Introduction to Linguistics in the 1990s", In Optimality Theory: An Overview. Blackwell, Maiden, MA.
Battistella Edwin 1990 Markedness: The Evaluative Superstructure of Language, SUNY Press, Albany, NY.
Battistella Edwin 1996 The Logic of Markedness, Oxford University Press, NY.
Chandler, Daniel 2002/2007 Semiotics: The Basics, Routledge, London, UK.
Chandler, Daniel 2005 Entry on markedness. In John Protevi (Ed.) (2005) Edinburgh Dictionary of Continental Philosophy, Edinburgh: University of Edinburgh Press.
Chomsky, Noam and Morris Halle 1968 The Sound Pattern of English, Harper and Row, NY
Greenberg Joseph Language Universals, Mouton, The Hague, 1966.
Trask, R.L. 1999 Key Concepts in Language and Linguistics, London and New York: Routledge.

UpToDate Contents

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Related Pictures

★リンクテーブル★

リンク元	「100Cases 14」「manifest」「salient」「intense」「striking」
拡張検索	「markedly」「hereditary progressive dystoniawith marked diurnal fluctuation」「marked line」
関連記事	「mark」

「100Cases 14」

　　[★]

☆case14　複視

■glossary

diplopia n. 複視

筋力低下、筋無力、筋脱力 muscle weakness, muscular weakness

sunken

vt. sinkのpp.

adj.

沈没した、沈んだ、水中の

沈下した、一段低いところにある

落ち込んだ、くぼんだ

3,4-ジアミノピリジン 3,4-diaminopyridine 3,4-DAP K+チャネル阻害薬;ランバート・イートン筋無力症治療

■症例

43-year-old woman

cheif complaint: diplopia

present history: diplopia and holding her head up ; more marked in the evenings, for the last 3 months. difficulty of chewing. voice has become quieter. weight loss (3kg / 6months). non-smoker. drinks about 15 units/week. no regular medication.

past history: no significant previous medical illnesses.

family history: lives with her husband and three children.

・診察 examination

looks well.

organ systems: normal; cardiovascular, respiratory, and abdominal systems.

muscle power; grossly normal. decrease after testing a movement repetitively.

motor function: normal; tone, coordination, reflexes and sensation.

bilateral ptosis. exacerbated by prolonged upward gaze

eye: normal; pupillary reflexes, eye movements, and funduscopy

■答え

diagnosis: myathenia gravis

differential diagnoses:

CASES

上位and/or下位運動ニューロン motor neurone disease　運動ニューロン疾患：線維束性攣縮。進行例では筋力低下

筋 muscular dystrophy　筋ジストロフィー：ある種の筋肉が選択的に筋力低下する。家族歴がある。

筋 dystrophia myotonica　強直性筋ジストロフィー：咬筋、側頭筋、胸鎖乳突筋の筋萎縮、四肢遠位端の筋萎縮。顔貌が特徴的(前頭部脱毛、無表情、窪んだ頬)。家族歴ある。筋電図が診断に有用(急降下爆撃音)。

筋 polymyositis　多発筋炎：普通は皮疹と関節痛が出現。CKが上昇。筋生検が診断に有用

筋 myopathy　ミオパチー：甲状腺中毒性ミオパチー、甲状腺機能低下症によるミオパチー、クッシング症候群によるミオパチー、アルコール性のミオパチー

神経筋接合部？ non-metastatic associations of malignancy (paraneoplastic syndrome(傍腫瘍性症候群 = 腫瘍随伴症候群)のこと)：胸腺腫の症例の10%に重症筋無力症がみられる。ランバート・イートン筋無力症症候群は小細胞癌と関連がある。

HIM.2674

神経筋接合部 congenital myasthenia syndrome　先天性筋無力症症候群
神経筋接合部 drug-induced myasthenia　薬剤性筋無力症

Treatment with penicillamine (used for scleroderma or rheumatoid arthritis) may result in true autoimmune MG, but the weakness is usually mild, and recovery occurs within weeks or months after discontinuing its use.

　重症筋無力症の誘発：ペニシラミン(強皮症や関節リウマチの治療に用いられる)。

　　mildだし、薬剤の中断で改善する。

Aminoglycoside antibiotics or procainamide can cause exacerbation of weakness in myasthenic patients; very large doses can cause neuromuscular weakness in normal individuals.

　重症筋無力症の悪化：アミドグリコシド系抗菌薬、プロカインアミド

　　MGの患者の筋脱力が悪化する。

神経筋接合部 Lambert-Eaton myasthenic syndrome　ランバート・イートン筋無力症症候群：全身の筋肉が冒されるが、特に下肢の近位筋が冒される。MGと同じように～70%の患者で脳神経所見(眼瞼下垂、複視など)が認められる。MGと違うのは(1)反射が消失・減弱すること、(2)自律神経系の変化(口渇、勃起不全)を生じる、(3)神経刺激検査で漸増(waxing)が見られることである。病因は神経筋接合部のP/Q type calcium channelsに対する抗体の出現であり、85%の患者で見いだされる。治療はMGのように血漿交換や免疫抑制薬が使われる。3,4-DAPやpyridostigmineは症状に対する治療のために用いる。前者は運動神経の終末部でカルシウムチャネルをブロックし活動電位を延長させる。後者はアセチルコリンエステラーゼを阻害してシナプスにおける神経伝達物質の濃度を上げる。
精神疾患 neurasthenia　神経衰弱症：歴史的な用語。器質的な障害を伴わない筋無力症のような脱力を伴う症候群。患者は筋脱力や疲労を訴えてやってくる。筋肉の検査では器質的変化は認めないが"jerky release"あるいは"give-away weakness"が認められる。患者の主訴は反復動作による筋力低下よりむしろ疲労や感情鈍麻である。
内分泌疾患 hyperthyroidism　甲状腺機能亢進症：MGが疑われる患者にはthyroid function testをルーチンにやる。甲状腺機能異常は筋無力症の筋力低下を大きくすることがある。
神経筋接合部 botulism　ボツリヌス症：ボツリヌス毒素はシナプス前膜からの神経伝達物質の開口分泌を妨げる。症状はbulbar weakness (複視、構音障害、嚥下困難)。感覚障害はない。深部腱反射は初期には保たれている。進行すれば反射は見られなくなる。筋脱力は全身性。呼吸困難に陥ることがある。精神状態は正常。自律神経症状(麻痺性イレウス、便秘、urinary retention、瞳孔の散大、瞳孔の反応性低下、口渇)。確定診断は血清中の毒素の検出だけど、見つかることはまれ。神経伝導検査(nerve conduction studies)：compound muscle action potentials (CMAPs)の低下。高頻度の刺激で振幅が増加。治療：intubation for airway protection、呼吸補助、aggressive inpatient supportive care(e.g., nutrition, DVT prophylaxis)。馬の抗毒素を検査結果が帰ってくる前に投与する(？)。
上位運動ニューロン intracranial mass lesions　頭蓋内占拠病変：複視はintracranial mass lesionが外眼筋の神経を圧迫することにより生じる。
筋 progressive external ophthalmoplegia　進行性外眼筋麻痺：外眼筋の筋脱力を伴う。四肢の近位筋の筋力低下やそのほかの全身症状を伴うことがある。ミトコンドリアの異常を有する。

■参考文献

HIM = Harrison's Principles of Internal Medicine 17th Edition

CASES = 100 Cases in Clinical Medicine Second edition

IMD = 内科診断学第2版

「manifest」

　　[★]

adj.

明白な、はんぜんとした、一目瞭然の。公知の。(精神分析)意識に現れた、顕在的な

vt.

明らかにする、明示する。証明する。(行為などによって)(感情などを)表す

vi.

(幽霊などが)現れる

osteomyelitis classically manifests as an acute systemic illness with malaise, fever, leukocytosis, and throbbing pain over the affected region.

In PAN, renal involvement most commonly manifests as hypertension, renal insufficiency, or hemorrhage due to microaneurysms. (HIM.2125)(結節性多発動脈炎では、一般的に腎病変は高潔悦、腎不全あるいは微小血管瘤による出血として現れる)