A Subtle Sighting: Acute Midbrain Infarction Presenting as Isolated Medial Rectus Palsy

Isolated ocular motor palsy involving one extraocular muscle is a rare clinical manifestation of cerebrovascular accident and is more commonly attributed to orbital trauma and muscular disease. Oftentimes, diplopia is the only symptom reported by patients. Differentiating between monocular and binocular diplopia is a fundamental step in the diagnostic pathway. Furthermore, a cautious and detailed neurological examination is required. We present a case of a 64-year-old male with isolated left medial rectus palsy secondary to an acute midbrain infarction, with no other manifestations or symptoms of acute stroke.