Bilateral sixth nerve pareses with temporal arteritis and diabetes.

A 78-year-old white woman presented with a 1-month history of neck and right shoulder pain and a 12-day history of acute horizontal diplopia. On examination, bilateral sixth nerve pareses were present, right greater than left. On evaluation, the patient was noted to have normal fasting blood sugars, but moderately elevated blood sugars after a glucose load. A temporal artery biopsy was performed which was positive. Whether diabetic or arteritic, bilateral sixth nerve pareses resulted in our patient seeking medical attention. By considering temporal arteritis, it is possible that blindness was avoided.