Magnetic Resonance Imaging Findings in a Patient With Nuclear Oculomotor Palsy

Oculomotor nuclear palsies are rarely observed without concomitant nonophthalmic neurological findings. We describe an isolated oculomotor nuclear palsy in a diabetic patient and correlate the spontaneous clinical improvement with radiologic images. Although the majority of diabetic oculomotor palsies may be peripheral and ischemic, we postulate they also can be central and hemorrhagic in nature.

Report of a Case.  A 60-year-old black woman with insulin-dependent diabetes, hypertension, and coronary artery disease presented with a sudden onset of horizontal diplopia. Ocular examination revealed bilateral ptosis that was worse on the left side, severe limitation of adduction, and a moderate decrease of infraduction and supraduction of the left eye. The right eye showed a mild decrease in supraduction secondary to a superior rectus paresis. A 30—prism diopter exotropia and a small right hypertropia were seen in the primary position. The findings of the rest of the neurological examination, including the pupil examination,