Teaching NeuroImages: Stroke presenting with isolated superior branch of cranial nerve III palsy

Abstract

A 53-year-old man presented with diplopia. On examination, he had mild to moderate right ptosis and limited supraduction in the right eye with no abnormalities of adduction, abduction, infraduction, or pupillary reactivity (figure, B-E). MRI brain revealed restricted diffusion consistent with acute infarction involving the medial aspect of the right cerebral peduncle (figure, A).