emphasizes the clinical importance of a careful patient history detailing the onset of ptosis, its variability, and its progression. A pattern of ocular and generalized muscle weakness is a central diagnostic attribute of impaired nerve conduction due to disease of the neuromuscular junction. Generalized myasthenia gravis, ocular myasthenia gravis, MuSK-myasthenia gravis, and a case of the Lambert-Eaton syndrome illustrate the spectrum of disorders of neuromuscular transmission. The syndrome known as chronic progressive external ophthalmoplegia is by far the most common of the mitochondrial myopathies progressing to the multisystem failure that is characteristic of the Kearns-Sayre syndrome. A case of Kearns-Sayre syndrome followed for 34 years is a unique case study. Two inherited forms of myopathy, oculopharyngeal muscular dystrophy and myotonic dystrophy, are included, together with a patient with the Guillain-Barré syndrome variant, Fisher syndrome. These disorders should always be considered in the differential diagnosis of bilateral progressive ptosis.
Positive ice test in a patient with atypical Miller Fisher syndrome, mimicking ocular myasthenia gravis
