NEURO-OPHTHALMOLOGIC MANIFESTATIONS OF DIABETIC CRANIAL NEUROPATHY: CLINICAL FEATURES AND NEUROLOGICAL ASSESSMENT

Abstract

Diabetic cranial neuropathy is a relatively rare but clinically important neurological complication of diabetes mellitus associated with dysfunction of cranial nerves and neuro-ophthalmologic impairment. The condition most commonly affects the oculomotor, abducens, and trigeminal nerves, leading to diplopia, ptosis, ophthalmoplegia, retro-orbital pain, and sensory disturbances. Despite increasing prevalence of diabetes mellitus worldwide, diabetic cranial neuropathy remains insufficiently investigated, particularly regarding objective neurological assessment and clinical manifestations. The present study aimed to evaluate neuro-ophthalmologic manifestations and neurological impairment in patients with diabetic cranial neuropathy using standardized neurological assessment scales. This observational clinical study included 10 patients with diabetes mellitus presenting with signs of cranial nerve dysfunction who underwent neurological evaluation and treatment. The study population consisted of 6 women (60%) and 4 men (40%), with a mean age of 54±1.8 years. Neurological severity was assessed using the Neurological Symptom Score (NSS) and Neuropathy Disability Score (NDS). Clinical manifestations, duration of diabetes mellitus, vascular comorbidities, and therapeutic outcomes were analyzed. The results demonstrated that oculomotor nerve involvement was the most frequent neurological finding and was observed in 50% of patients. Abducens nerve dysfunction was identified in 30% of patients, while trigeminal nerve involvement was detected in 20% of cases. Diplopia represented the predominant neuro-ophthalmologic manifestation, occurring in 70% of patients, followed by limitation of extraocular eye movements (60%), ptosis (50%), retro-orbital pain (40%), and facial hypoesthesia (20%). Mean NSS and NDS values indicated moderate neurological impairment among the examined patients. Higher neurological severity scores were observed in patients with long-standing diabetes mellitus and concomitant vascular complications. Following comprehensive therapeutic management, positive neurological improvement was observed in the majority of patients during the follow-up period. The findings emphasize the importance of early neurological and neuro-ophthalmologic assessment in diabetic patients presenting with cranial nerve dysfunction. The use of NSS and NDS scales may improve objective evaluation of neurological impairment and facilitate timely therapeutic intervention in diabetic cranial neuropathy.