Cranial neuropathies in uncontrolled diabetes: May not always be due to diabetic microangiopathy

Description

A 22-year-old man, detected to have type 1 diabetes at the age of 9 years, presented with left-sided frontotemporal headache for 1 week followed by left-sided ptosis and binocular diplopia for 4 days. The headache was deep seated and his ocular complaints were of insidious onset and progressive in nature. On admission, he was afebrile with normal vitals except for elevated blood pressure (160/110 mm Hg). He had left-sided complete ophthalmoplegia (palsies of III, IV and VI cranial nerves) along with loss of sensations along the distribution of the ophthalmic division of the left trigeminal nerve (figures 1 and  2). The pupils were equal and reacting to light and the plantar responses were down going. Anterior and posterior rhinoscopy did not reveal any bloody discharge or black eschars. Baseline biochemistry on admission revealed uncontrolled blood sugars (fasting plasma glucose: 198 mg/dL; postprandial plasma glucose: 324 mg/dL; haemoglobin A1c: 9.5%) and deranged renal...

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