Midbrain Infarction Resulting in Bilateral Pseudoabducens Palsies

Introduction: Pseudoabducens palsy refers to abduction paresis in the absence of a pontine or peripheral nerve process. This finding has been described with mesodiencephalic lesions, and likely has a common mechanism with thalamic esotropia.Case Report:We describe the case of a 55-year-old man who presented with near-complete ophthalmoparesis, sparing only adduction of the left eye. Magnetic resonance imaging of the brain demonstrated midbrain infarction.Conclusions:Pseudoabducens palsy is likely underrecognized, but can be highly localizing when identified. Possible pathophysiologic mechanisms for this finding are discussed.