RESUMO
BACKGROUND: Neuropathy is a frequent complication in diabetic patients with variable clinical presentations and evolutions. AIM: The purpose of the study was to specify the clinical features of diabetic third nerve palsy, to assess the risk factors and to observe its evolution. METHODS: We report a series of 11 diabetic patients with oculomotor paralysis collected in the department of endocrinology and diabetology of FarhatHached Hospital of Sousse between 1996 and 2005. RESULTS: Our study was about 6 men and 5 women with an average age of 63.6 ± 13.7 years. All patients had type 2 diabetes. Eight patients presented with diplopia, three with periocular pain and 6 with headache. The oculomotor palsy was unilateral in all cases. All patients were in glycemic imbalance at the time of the diagnosis of ptosis and they were at high cardiovascular risk. The evolution under optimal equilibrium of diabetes and control of cardiovascular risk factors was marked by regression and disappearance in 4 patients, homo or contralateral recurrence in 4 patients and persistence of the palsy in 1 patient. CONCLUSION: Glycemic equilibrium and ischemic phenomena due to cardiovascular risk factors are at the root of these oculomotor paralyses in diabetic patients. The evolution of diabetic mononevritis remains unpredictable despite the control of blood glucose levels and cardiovascular risk factors.
Assuntos
Diabetes Mellitus Tipo 2 , Neuropatias Diabéticas , Doenças do Nervo Oculomotor , Oftalmoplegia , Idoso , Neuropatias Diabéticas/complicações , Neuropatias Diabéticas/diagnóstico , Neuropatias Diabéticas/epidemiologia , Diplopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Nervo Oculomotor/diagnóstico , Doenças do Nervo Oculomotor/epidemiologia , Doenças do Nervo Oculomotor/etiologiaRESUMO
Diabetes in the elderly is increasing significantly in medical practice. This retrospective study is about 261 patients over 60 years of age at the diagnosis of diabetes. The main conditions of diagnosis were fortuitous discovery [50, 9%], cardinal signs [23, 3%] and complication in 19, 2% of the cases. Systematic screening was rare [6, 9%]. A microangiopathy was seen in 27, 6% of the cases corresponding to an undetected diabetes and vascular lesions were found in 15, 7% of the cases. The majority of patients had type 2 diabetes [95, 8%] and 8,896 of them were already requiring insulin therapy. 44.4% of the patients were also treated for other conditions and 19.9% had a handicap. Our results suggest the need for an early screening and for a complete clinical and etiologic evaluation when diabetes is found in the elderly