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A Subtle Sighting: Acute Midbrain Infarction Presenting as Isolated Medial Rectus Palsy
Salomon Chamay1, Ermias Greffie1, Francisco J Gallegos Koyner2
1Internal Medicine, SBH Health System, New York City, USA.
Cureus
|August 19, 2025
Summary
Isolated ocular motor palsy, a rare stroke symptom, can cause double vision. This case highlights a midbrain infarction leading to isolated medial rectus palsy, emphasizing the need for thorough neurological exams.
Area of Science:
- Neuroscience
- Ophthalmology
- Neurology
Background:
- Isolated ocular motor palsy is uncommon in cerebrovascular accidents, often mistaken for trauma or muscle issues.
- Diplopia is a frequent symptom, necessitating differentiation between monocular and binocular causes.
Observation:
- A 64-year-old male presented with isolated left medial rectus palsy.
- The patient reported diplopia as the sole symptom.
Findings:
- The palsy was diagnosed as secondary to an acute midbrain infarction.
- No other acute stroke manifestations were present.
Implications:
- This case underscores the importance of considering cerebrovascular accidents in isolated ocular motor palsies.
- Detailed neurological examination is crucial for accurate diagnosis and timely intervention.
