2 min. upgaze test positive, pupillary function normal. eom's normal. no diplopia. tft's (full panel), achase ab, achr-ab, anti-musk ab, all neg.

Ptosis: Was the ptosis unilateral or bilateral? Did the patient have a single-fiber EMG study yet? Sounds like a neuromuscular problem despite the negative workup to date.

Impressions: Although so far, this does not seem to prove myasthenia, would wonder about Tensilon test or single fiber EMG (per Dr Nahm), but have seen ptosis fatigue and have positive Tensilon response even in absence of true neuromuscular junctional process. Might also consider myopathic presentation, such as later presentation of a dystrophic disorder.