Sixth-nerve palsy in a patient with uncontrolled type 1 diabetes

Abstract

Background/objective

Oculomotor palsy is one of the most frequent neuro-ophthalmologic complications in patients with diabetes. Specifically, sixth nerve palsy is the most common.

Case report

A 51-year-old female with a past medical history of type 1 diabetes on insulin and hypertension presented with complaints of worsening headache and diplopia. Physical exam was remarkable for recurrent sixth-nerve palsy. Patient was hemodynamically stable. Labs showed blood glucose of 367 mg/dL (70–100 mg/dL), an anion gap of 2 mmol/L (3–13 mmol/L), creatinine of 0.61 mg/dl (0.66–1.25 mg/dL), sodium of 129 mmol/L (135–145 mmol/L), and potassium of 4.4 mmol/L (3.5–5.1 mmol/L). Her hemoglobin A1C was 13.0 % Her complete blood count shows a white blood cell count of 6000/μL (3600-10,700/μL) and a hemoglobin of 14 g/dL (13.0–18.0 g/dL). Magnetic resonance venography of the head was negative for cerebral venous sinus thrombosis and magnetic resonance imaging of the brain was negative for acute abnormalities. Blood glucose readings improved during hospitalization after optimizing her insulin regimen. She was recommended to follow-up with outpatient endocrinology to discuss use of an insulin pump to better control her diabetes.

Discussion

Sixth-nerve palsy is a frequent but lesser-known neuro-ophthalmologic complication of poorly controlled diabetic patients.

Conclusion

Studies have shown a higher incidence of diabetes in patients with sixth-nerve palsy, warranting a more focused medical evaluation along with close observation and tighter control of blood glucose levels and hemoglobin A1C.