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Brainstem stroke presenting as isolated bilateral ptosis
  1. Sunil James and
  2. Karunakaran Pradeep Thozhuthumparambil
  1. Department of Acute Internal Medicine, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
  1. Correspondence to Dr Sunil James; sunil.james1{at}


Pure midbrain infarctions not involving surrounding structures are an uncommon clinical phenomenon. A midbrain infarction that results in isolated bilateral ptosis as the only neurological deficit is much rarer and an easy diagnosis to miss; therefore, potentially leading to further downstream complications. We describe the case of an elderly patient who presented with isolated bilateral ptosis, initially thought to be consequent to myasthenia gravis but subsequently identified to have a perforator infarct in the midbrain, resulting in his symptoms.

  • brain stem / cerebellum
  • clinical neurophysiology
  • cranial nerves
  • stroke

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  • Contributors SJ drafted the paper. KPT edited and finalised the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.