Zanella Gavin S, Brooks Branden, Lui Forshing
Neurology, University of California (UC) Davis Medical Center, Sacramento, USA.
Clinical Sciences, California Northstate University College of Medicine, Elk Grove, USA.
Cureus. 2024 Nov 24;16(11):e74346. doi: 10.7759/cureus.74346. eCollection 2024 Nov.
The finding of pupil-sparing third nerve palsy is synonymous with diabetic third nerve palsy in the minds of many clinicians. While this is the most common cause of a third nerve palsy with normal pupillary response, it is not the only cause. We present the case of an elderly diabetic gentleman who presented with pupil-sparing third nerve palsy and gait abnormalities without any weakness or incoordination in the extremities. He was initially diagnosed with a third cranial nerve mononeuropathy due to poorly controlled type 2 diabetes but was later found on MRI to have a small ischemic stroke in the dorsal midbrain. This case highlights the importance of a thorough neurological examination and the findings in such an exam that should prompt clinicians to consider etiologies other than diabetes in patients presenting with a pupil-sparing third nerve palsy. As discussed below, failure to recognize these differential diagnoses can result in poor outcomes for patients.
在许多临床医生的观念中，发现瞳孔保留的动眼神经麻痹就等同于糖尿病性动眼神经麻痹。虽然这是瞳孔反应正常的动眼神经麻痹最常见的病因，但并非唯一病因。我们报告一例老年糖尿病男性患者，该患者表现为瞳孔保留的动眼神经麻痹和步态异常，四肢无任何无力或共济失调。他最初被诊断为2型糖尿病控制不佳导致的动眼神经单神经病，但后来MRI检查发现中脑背侧有一个小的缺血性卒中。该病例强调了全面神经系统检查的重要性，以及此类检查中的发现应促使临床医生在出现瞳孔保留的动眼神经麻痹的患者中考虑糖尿病以外的病因。如下所述，未能识别这些鉴别诊断可能会给患者带来不良后果。
