A 43-year-old woman presents to her GP complaining of diplopia, more marked in the evenings, for the last three months. She has noticed difficulty holding her head up, especially in the evenings. She has problems finishing a meal because of difficulty chewing. Her husband and friends have noticed that she has become quieter. She has lost about 3 kg weight in the past six months. She is a non-smoker and drinks about 15 units of alcohol per week. Examination Cardiovascular, respiratory and abdominal systems examination was normal.
Power in all muscle groups was grossly normal but seems to decrease after testing a movement repetitively. Tone, coordination, reflexes, and sensation were normal. Bilateral ptosis was present and it exacerbated by prolonged upward gaze. Pupillary reflexes, eye movements, and fundoscopy were normal. What is the likely diagnosis? *This case is from Docplexus…
