PMC4750319_01
(a) Clinical photograph showing the presence of bilateral ptosis. (b) Magnetic resonance imaging orbit is showing the absence of any extraocular muscle thickening. (c) Marked improvement in ptosis after neostigmine administration (positive response). (d) High-resolution computerized tomography thorax revealing mildly enlarged thymus gland (white arrow)
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F1
She had bilateral ptosis with incomplete external ophthalmoplegia [Figure 1a]. Magnetic resonance imaging study of the brain was normal, and that of orbit did not show any evidence of proptosis or extraocular muscle thickening [Figure 1b]. However, the patient showed significant improvement in ptosis and external ophthalmoplegia with neostigmine test [Figure 1c]. High resolution computerized tomography without contrast of thorax revealed the presence of a mildly enlarged thymus (antero-posterior diameter 18 mm) [Figure 1d].