Midbrain Infarction Resulting in Bilateral Pseudoabducens Palsies

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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.


Pseudoabducens palsy is likely underrecognized, but can be highly localizing when identified. Possible pathophysiologic mechanisms for this finding are discussed.

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