This case report explores the presentation, diagnosis, and management of a 60-year-old female patient with right Lateral Rectus (LR) palsy, a manifestation of abducens nerve dysfunction. The patient, with a history of Type 2 Diabetes Mellitus, presented with Giddiness, Blurred vision, and Facial palsy. Initial investigations revealed elevated random blood glucose levels. Neuroimaging, specifically brain MRI, confirmed chronic small vessel ischemia as the underlying cause. The patient initially declined hospital admission but was prescribed a combination of medications. Subsequent follow-ups revealed worsening double vision and blurred vision over the following week. Further treatment involved a three-day hospital stay, during which intravenous Methylprednisolone was administered. The patient responded positively, and left abducens nerve palsy completely resolved within one week. The discussion highlights the prevalence of microvascular causes in adults, differing from pediatric trends, and emphasizes the importance of considering various etiological factors such as Diabetes, Hypertension, and Immunologic damage. The study advocates for thorough Neuroimaging in cases lacking clear risk factors or suggestive clinical findings. The conclusion underscores the significance of proper follow-up, especially for initially idiopathic cases, to facilitate a more precise diagnosis based on evolving clinical manifestations.
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