Fluctuating double vision and ptosis are the hallmarks of extraocular muscle weakness in myasthenia gravis (MG). On sustained upward gaze, ptosis usually increases temporarily. The first description of using this fatigue sign has been attributed to the Scottish neurologist John Simpson. Cogan added his lid-twitch sign to the diagnostic bedside armamentarium.1 For many years, we have applied a fatigue-recovery test at the bedside, whereby the strength of the previously fatigued levator palpebrae muscle is improved shortly after voluntary …
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