In patients presenting
with eyelid ptosis the clinician considers a differential diagnosis of 3rd
nerve palsy, Horner’s syndrome, mitochondrial myopathy, oculopharyngealmuscular dystrophy, levator dehiscence, myotonic dystrophy and myastheniagravis.
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| Dropped Brow Sign |
The presence of moment to
moment fluctuation in severity of ptosis (fatigable ptosis) typically suggests
a neuromuscular junction disorder of which myasthenia gravis is the only common
form. Patients may also present with symptoms or signs that are psychological
in origin. We present a case of ptosis associated with the “dropped brow sign”
(initially misdiagnosed as myasthenia gravis). This finding is evidence for
psychogenic pseudo-myasthenic ptosis and should direct the clinician towards
early exploration of a psychological component to the patient’s symptoms.
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