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Progressive bilateral ptosis in a patient with midbrain metastasis and chronic inflammatory demyelinating polyradiculoneuropathy
  1. Diego Kaski,
  2. Lionel Ginsberg
  1. Royal Free Hospital, London, UK
  1. Correspondence to Dr Diego Kaski, Royal Free Hospital, Pond Street, London NW3 2QG, UK; d.kaski{at}imperial.ac.uk

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A 68-year-old woman gave a 2-month history of progressive partial closure of the right eyelid, subsequently involving the left eyelid, with no other visual symptoms. She had presented 2 years previously with patchy paraesthesia and predominantly distal weakness in the upper limbs, progressing to the feet over 5 days, with absent tendon reflexes and mild distal sensory loss. She had been treated with intravenous immunoglobulin (IVIg; 400 mg/kg daily for 5 days) for presumed Guillain–Barré syndrome and gradually recovered. Four months later she developed deteriorating motor function and lower thoracic back pain—but no change in bladder or bowel function. Investigations confirmed a demyelinating neuropathy, with nerve conduction studies fulfilling electrodiagnostic criteria for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP).1 Cerebrospinal fluid was acellular with a protein concentration of 1.19 g/L (normal <0.45). Important normal/negative results included serum protein electrophoresis and immunofixation, serum antineuronal antibodies, MR scan of whole spine, skeletal survey and CT scan of chest, abdomen and pelvis. She …

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