Oculomotor Palsies, a Case Report of Combined or Multiple Diabetic Cranial Neuropathy

Abstract

Multiple oculomotor palsies are a rare condition. They typically present with ptosis, diplopia and preserved pupillary function. We present the case of a 65-year-old woman with a history of diabetes and arterial hypertension, initially presenting with headache and later developing diplopia, progressive left palpebral ptosis and fluctuating pupillary response. She was diagnosed with unilateral paralysis of cranial nerves III and IV. Extension studies were performed and, ultimately, the Neurology Department diagnosed microvascular ischemia due to diabetes. Metabolic and blood pressure therapy was adjusted; two months later, complete recovery was achieved. Multiple oculomotor palsy is a diagnostic challenge in the general medical practice. Fluctuating pupillary response, or anisocoria, may be caused by neoplasms or aneurysms in the posterior communicating artery, with potentially devastating consequences. Therefore, judicious clinical evaluation is crucial for etiological diagnosis and appropriate treatment.

Keywords

• blepharoptosis
• diabetes mellitus
• diabetic neuropathies
• diplopia
• ophthalmoplegia