68-year-old female patient with diplopia. Diplopia secondary to CN 3 palsy OS thought related to DM. There is apparent mild T2 hyperintensity circumferentially along the bilateral inferior rectus muscles. Otherwise, the bilateral extraocular muscles are not particularly enlarged or atrophic. There are bilateral lens implants. The optic nerves are unremarkable bilaterally. There is no evidence of intraorbital mass lesions. The cisternal segments of the oculomotor nerves and cavernous sinuses are unremarkable. There are scattered foci of T2 hyperintensity in the imaged portions of the cerebral white matter.
1. Apparent mild T2 hyperintensity circumferentially along the bilateral inferior rectus muscles is likely artifactual rather than related to early denervation effects or thyroid eye disease. However, assessment is limited due to the lack of intravenous contrast.2. Nonspecific scattered foci of T2 hyperintensity in the imaged portions of the cerebral white matter may represent small vessel ischemic disease.