Rare Case of Simultaneous Diabetic Oculomotor and Trochlear Nerve Neuropathy: Case Report

Abstract

INTRODUCTION: Diabetic cranial neuropathy is a spectrum of diabetic neuropathy. Isolated cranial nerve involvement is common as the manifestation of diabetic cranial neuropathy. The cranial nerve that frequently involved are abducens and oculomotor nerve, trochlear nerve is the least involved. Simultaneous cranial nerve involvement is not common and need further investigation for other possible etiology. CASE REPORT: We reported a 52-year-old, diabetic and hypertensive male, presented with acute onset, first ever, severe temporal headache with left eye ptosis, diplopia and opthalmoplegia. Neurologic examination revealed left oculomotor and trochlear nerve palsy with sparring of pupillary function. Examination of blood D-dimer and C-reactive were normal. Head contrast MRI and MR Angiography revealed no lesion. He was diagnosed with diabetic cranial neuropathy after exclusion of other possible etiology. CONCLUSION: Simultaneous involvement of two or more cranial nerve neuropathy in diabetic patient is not common and need further investigation. Exclusion of the other possible diagnosis is important to diagnose diabetic cranial neuropathy.