Question category: Neurology
A 52 year old female presents after noticing for some months both eyelids drooping. She is complaining of double vision. She is also complaining of difficulty climbing stairs,getting up from chairs and brushing her hair. She states this is worse after exertion and at the end of the day. On examination the patient can only look up for a few seconds before the eyes start to drift back down. There is evidence of bilateral ptosis and her face has a mask like expression. There is evidence of proximal muscle weakness but sensation and reflexes are normal.