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

## TL;DR

A rare case of isolated eye muscle paralysis was caused by a midbrain stroke, highlighting the importance of thorough neurological exams.

## Contribution

This case report highlights an unusual presentation of midbrain infarction as isolated medial rectus palsy.

## Key findings

- Isolated medial rectus palsy can be a rare sign of acute midbrain infarction.
- No other stroke symptoms were present in the reported case.
- Accurate differentiation of diplopia type is crucial for diagnosis.

## Abstract

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.