Bilateral Central Ptosis as a Presenting Manifestation of a Dorsal Midbrain Tumor

A 61-year-old female presents with a two-month history of sudden onset bilateral lid droop which was maximal at onset. The patient tilts her head backwards 'in order to see'. The lid droop was worse in the morning, and exacerbated by fatigue. The lid droop was unassociated with diplopia, dysphagia, neck weakness and proximal muscle weakness. There is no history of myasthenia gravis or family history of ptosis. The patient has a previous history of fibrocystic disease involving the right breast, without evidence of malignancy. She does not smoke and has history of hearing loss.