Acquired double depressor palsy following bilateral medial thalamus and left midbrain infarction

We present the case of a 57-year-old man with vertical diplopia who was diagnosed with acquired left eye supranuclear double depressor palsy after ischemic stroke, with small infarcts at the bilateral medial posterior thalami, left midbrain, and left occipital lobe. Given the different innervation of the two depressors, intact vestibulo-ocular reflex, and the healthy inferior rectus muscle morphology observed intraoperatively, the lesion likely involved the supranuclear vertical gaze center or its pathway. His strabismus was treated successfully with recession and resection of vertical rectus muscles, resulting in no significant deviation in either the vertical or horizontal directions in primary gaze at 6 months' follow-up.