<prompt> Ptosis with weakness of orbicularis-oculi is an early feature of :Fisher syndromeMyasthenia gravisEaten lambe syndromeThyrotoxicosis  <response>: B i.e. Myasthenia gravis Myasthenia gravis in a major cause of ptosis diplopia Q. The distribution of muscle weakness has a characteristic pattern. The cranial muscles paicularly the lids and extraocular muscles are often involved early in the course Q of MG, and diplopia and ptosis are common initial complaints. Differential diagnosis of weakness of cranial extra-ocular musculature Myasthenia It involves women in their 20-30s and men in their 50-60s gravis Women are affected more than men 3:2 The cardinal features are weakness and fatigability Q of muscles. The weakness increases during repeated use fatigue and may improve following rest or sleep. The cranial muscles, paicularly the lids extraocular muscles are often involved early in the course, diplopia and ptosis are common initial complaints Q. Weakness in chewing, snarling expression on attempt to smile, difficulty in swallowing may be other complaints The limb weakness in 85 of all patients is proximal asymmetricalQ. Despite the muscle weakness, deep tendon reflexes are preserved Q and sensations are normal Anti-acetylcholine receptor antibody Q anti-Ach R antibody is viually diagnostic but a negative test does not exclude the disease. The measured level of Anti-Ach-R antibody does not correspond well with the severity of MG in different patients. However, a treatment induced fall often correlates with clinical improvement in individual patient. Anti-muscle specific kinase antibody Q MUSK is found in 40 of Ach R-antibody negative patients with generalized MG. It is not present in Ach R-antibody positive patients or in patients with MG limited to ocular disease Repetitive nerve stimulation of weak or proximal muscle 6-24 hr after stopping anti Ach E medication; rapid reduction of 10-15 in amplitude of evoked response at 3Hz often provides helpful diagnostic evidence. Edrophonium may prevent or diminish this decrementa response highly probable Single fiber electromyography : blocking Jitter, with normal formal density; confirmatory, but not specific. Edrophonium chloride tensilon 2 mg 8mg IV Anti cholinesterase test is used most commonly for diagnostic testing because of rapid onset -30 sec and sho duration -5min of its effete. Diagnosis is highly probable if test unequivocally positive. For ocular or cranial MG exclude intracranial lesion by CT or MRI. 