Q: My 78 years old grandfather recently underwent a surgery for fungal infection in the sinus and has also been diagnosed as a diabetic. After his surgery; he had some kind of paralytic attack and one of his eyes (the infected side) got automatically closed. He was recovering from this, when the vision in the other eye started to haze out due to diabetic retinopathy. He is on treatment for this with ant-diabetic medications. During this time, he has lost his appetite and has been in some depression due to his state of illness. Over the past 3-4 days, we have observed that has started behaving strangely like he is forgetting people, hallucinating about things and persons who were not in front of him, trying to converse when no one is around, etc. This state keeps fluctuating with a very normal state where he understands and talks everything as a normal person would. Can you please guide us as to why is this happening and what can be done?

A:Because of his age and diabetes, his blood vessels in the brain are blocked like stroke, which has paralysed one of the eye nerves (3rd cranial nerve). This has caused the upper lid to close and also optic nerve (2nd cranial nerve) may have suffered ischaemic attack, which has caused hazy vision. If the diabetes was detected recently, it is unlikely to be diabetic retinopathy. General ischaemia of the brain has caused his state of the mind like this. Only other possibility I can think of at this age is a condition called Cranial arteritis, which is very serious and requires heavy dose of steroid treatment but this will make his diabetes worse. CT or MRI scan of the brain would show extent of brain or atrophic changes. Blood pressure and diabetes needs to be controlled properly.