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A 64-year-old woman, diabetic and hypertensive, presented with sudden onset painless diplopia and alteration of consciousness. She was drowsy with neurological examination revealing exotropia of both eyes in primary position with bilateral internuclear ophthalmoplegia on attempted horizontal gaze (Figure 1a). Pupils were normal bilaterally. Convergence, vertical saccades, pursuits and vestibular ocular reexes were impaired. Cranial magnetic resonance imaging (MRI) showed an acute infarct in the midline of mesencephalic …

Wall-eyed bilateral inter nuclear ophthalmoplegia with vertical gaze palsy