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Bilateral sixth nerve pareses with temporal arteritis and diabetes
Journal of Clinical Neuro-Ophthalmology
|June 1, 1986
Summary
This case study highlights how bilateral sixth nerve palsies, a symptom of temporal arteritis or diabetes, led to prompt medical attention. Early diagnosis of temporal arteritis potentially prevented vision loss.
Area of Science:
- Ophthalmology
- Neurology
- Rheumatology
Background:
- Giant cell arteritis (GCA), also known as temporal arteritis, is a systemic vasculitis affecting medium and large arteries.
- Cranial nerve palsies, particularly involving the sixth cranial nerve (abducens nerve), can be an initial manifestation of GCA.
- Diabetes mellitus can also cause sixth nerve palsies, often presenting as an "ischemic mononeuropathy."
Observation:
- A 78-year-old woman presented with neck pain, shoulder pain, and acute horizontal diplopia.
- Examination revealed bilateral sixth nerve pareses, more pronounced on the right.
- Laboratory evaluation showed normal fasting blood glucose but moderately elevated post-glucose load levels, suggesting impaired glucose tolerance or mild diabetes.
Findings:
- Temporal artery biopsy was positive for inflammation, confirming the diagnosis of temporal arteritis.
- The bilateral sixth nerve palsies were attributed to the arteritic process.
- The patient's glucose intolerance was noted as a potential confounding or coexisting factor.
Implications:
- Prompt diagnosis and treatment of temporal arteritis are crucial to prevent irreversible complications such as blindness.
- Bilateral sixth nerve palsies, while uncommon, should raise suspicion for GCA, especially in older adults.
- This case underscores the importance of a thorough diagnostic workup, including biopsy, for suspected GCA to guide appropriate management and preserve vision.