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Recurrent cranio-oculo-facial diabetic complication.

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Recurrent diabetic cranial neuropathy, often affecting the third cranial nerve, can cause vision problems. This case highlights a patient experiencing multiple episodes, emphasizing the need for awareness and management of diabetic complications.

Keywords:
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Area of Science:

  • Neurology
  • Endocrinology
  • Ophthalmology

Background:

  • Diabetic cranial neuropathy is a common complication of diabetes, frequently impacting the 3rd, 4th, and 6th cranial nerves.
  • Recurrent episodes are less commonly reported, with unclear incidence and typically benign, self-remitting courses.

Observation:

  • A 47-year-old male with diabetes presented with recurrent acute onset diplopia and ptosis.
  • Examination revealed right-sided pupil-sparing third cranial nerve palsy, with normal visual acuity and fundus showing early nonproliferative diabetic retinopathy.

Findings:

  • Laboratory results indicated poor glycemic control (HbA1C 8.8%) and elevated creatinine.
  • Brain imaging (CT and MRI) ruled out acute infarct or mass lesions, and CSF analysis was largely unremarkable.

Implications:

  • This case underscores the potential for recurrent diabetic cranial neuropathy, even with seemingly controlled diabetes.
  • Prompt recognition and management, potentially including corticosteroids, are crucial for favorable outcomes in recurrent cases.