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Updated: Mar 3, 2026

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Published on: November 12, 2020
Midbrain Infarction Resulting in Bilateral Pseudoabducens Palsies
Bonnie M Kaas1, David S Zee, Amir Kheradmand
1Departments of *Neurology †Ophthalmology ‡Otolaryngology-Head and Neck Surgery §Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD.
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.
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