In patients presenting with eyelid ptosis the clinician considers a differential diagnosis of 3rd nerve palsy, Horner’s syndrome, mitochondrial myopathy, oculopharyngeal muscular dystrophy, levator dehiscence, myotonic dystrophy and myasthenia gravis. The presence of moment to moment fluctuation in severity of ptosis (fatigable ptosis) typically suggests a neuromuscular junction disorder of which myasthenia gravis is the only common form. Patients may also present with symptoms or signs that are psychological in origin. We present a case of ptosis associated with the “dropped brow sign” (initially misdiagnosed as myasthenia gravis). This finding is evidence for psychogenic pseudo-myasthenic ptosis and should direct the clinician towards early exploration of a psychological component to the patient’s symptoms. Evaluation and management options for psychogenic disorders are summarized herein with a focus on recommendations for psychotherapy approaches that include the Creative Arts Therapies treatment and research potentials.
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