Ptosis

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Ptosis

Author: Pediatric Oncall

Question
A 3½ years old boy born of non-consanguineous marriage presented with diarrhea 15 days ago that lasted for 3 days and bilateral ptosis, dysarthria and fatigability since 1 day. There is no fever, convulsions or weakness. He had received pulse polio 2 days ago. There were no bladder, bowel complaints. On examination, he had bilateral ptosis, poor gag, waddling gait and truncal ataxia. Lower motor neuron facial palsy was present. Tone, power, reflexes were normal. Other examination findings were normal. Investigations showed:

• MRI brain = Normal
• CSF = No cytoalbuminemic disassociation
• CSF lactate = Normal
• EMG/NCV = Myopathic changes

What is the likely diagnosis?