Simultaneous, painless, homolateral oculomotor and trochlear nerve palsies in a patient with type 2 diabetes mellitus. Neuropathy or brainstem infarction?
Combined palsies of cranial nerves, especially of the oculomotor nerves, are distinctly uncommon, even in patients with diabetes mellitus. We present a patient with type 2 diabetes mellitus, arterial hypertension and hyperlipidaemia, who had simultaneous oculomotor and trochlear nerve palsies. An MRI scan showed multiple brainstem ischaemic infarcts. The patient was treated with intensified insulin regimen and clopidogrel. Symptoms gradually improved, and at 9 months there was no further improvement.
Papanas
N
N
Second Department of Internal Medicine, Democritus University of Thrace, Greece. papnasnikos@yahoo.gr
Heliopoulos
I
I
Piperidou
H
H
Maltezos
E
E
D000368:Aged; D002544:Cerebral Infarction / Q000175:diagnosis*; D000077144:Clopidogrel; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003925:Diabetic Angiopathies / Q000175:diagnosis*; D003929:Diabetic Neuropathies / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006949:Hyperlipidemias; D006973:Hypertension; D007328:Insulin / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D010243:Paralysis; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome
D007328:Insulin; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine