Abducens Nerve Palsy and Peripheral Neuropathy in a Hypertensive Emergency With Uncontrolled Diabetes Mellitus: A Case Report

Sixth cranial nerve palsy is a rare but important finding in patients presenting with acute neurological symptoms, particularly when accompanied by long standing diabetes and uncontrolled hypertension. We report a case of a 55-year-old male with a history of poorly controlled diabetes mellitus, hypertension, and dyslipidemia who presented with progressive generalized weakness, dizziness and right eye movement limitation. Initial evaluation suggested a hypertensive emergency with diabetic mononeuropathy; however, further neurological assessment revealed conjugate gaze palsy consistent with one and a half syndrome, raising suspicion for a brainstem stroke. Imaging revealed old lacunar infarcts and ophthalmology confirmed bilateral diabetic retinopathy with optic neuropathy. The patient was managed with antihypertensives, insulin and antiplatelet therapy and remained clinically stable. This case underscores the importance of thorough neurological evaluation in high risk patients and the need to consider brainstem stroke in the differential diagnosis of isolated cranial nerve palsy.