Bilateral Ptosis and Limb Myokymia: Regional Variant of Guillain-Barré Syndrome?

Isolated bilateral ptosis as an initial sign of Guillain-Barré Syndrome (GBS) with subsequent limb paralysis or paresis has been reported. However, to our knowledge, bilateral ptosis with subsequent limb myokymia but without ophthalmoplegia, facial or extremity weakness has not been observed. Our patient developed severe bilateral ptosis over several days. There was no facial or extremity weakness although limb myokymia was seen. Laboratory studies excluded common causes of ptosis and were suggestive of GBS. We believe our patient extends the clinical spectrum of GBS, and that binocular ptosis represents a mild regional variant of this neuropathy.