Combined Up- and Downgaze Palsy Associated Temporarily with a Unilateral Midbrain Infarction

and reactive normally to light, associated with subtle left eyelid ptosis. Five days later, his diplopia had resolved. On voluntary vertical gaze, trace upward and downward movement returned. Oculocephalic maneuver elicited downward saccade but failed to hold the downward gaze, and elicited no upward gaze ( fig. 1 A). Vertical saccades and pursuit returned normal on follow-up examination 2 weeks after onset. Bell’s phenomenon was absent throughout his clinical course. MRI 7 days after onset showed fresh lacunar infarction in the midbrain tegmentum extended around the dorsal rim of the red nucleus on the left.