# A Rare Case of Isolated Abducens Nerve Palsy With Contemporaneous Thalamic Infarct

## TL;DR

A rare case links isolated abducens nerve palsy with a thalamic infarct in a patient with multiple health issues.

## Contribution

This is the first reported case linking isolated abducens nerve palsy with a contemporaneous thalamic infarct.

## Key findings

- Isolated left abducens nerve palsy occurred alongside a right thalamic infarct.
- MRI showed restricted diffusion in multiple brain regions.
- Symptoms improved with antiplatelet, antihypertensive, and hypoglycemic treatment.

## Abstract

We report a case of isolated left abducens nerve palsy accompanying a right thalamic infarct. The patient, a 43-year-old Malay male with newly diagnosed hypertension, diabetes mellitus, and dyslipidemia, initially reported binocular diplopia on left lateral gaze persisting for five weeks. Subsequently, he experienced acute left-sided body weakness and slurred speech for over one day. Clinical examination revealed restricted left eye lateral gaze (-3) with no relative afferent pupillary defect. Additionally, decreased power (4/5) was noted in the left upper and lower limbs. Brain magnetic resonance imaging (MRI) revealed restricted diffusion in the right thalamus extending to the right posterior internal capsule, left anterior cingulate gyrus, and left caudate nucleus. The patient was initiated on antiplatelet, antihypertensive, and oral hypoglycemic agents, resulting in symptom improvement. This rare neuroophthalmological finding has not been reported previously.