Seeing double: check again! Isolated unilateral pseudoabducens palsy

Excerpt

The thalamus has a complex structure and its lesions can present with protean manifestations depending on the vascular territory involved [1]. Multiple ocular abnormalities, such as vertical gaze palsies, skew deviation, convergence problems, nystagmus, third nerve palsy or deficits in saccades, or smooth pursuits, may be seen with thalamic lesions [2]. More commonly, such ocular abnormalities are seen with midbrain and lower brain stem lesions. It is essential, therefore, for the clinician to correctly differentiate between classic infranuclear abducens nerve palsy from supranuclear pseudoabducens palsy, as their management and prognosis differ [3]. Pseudoabducens palsy as an isolated manifestation of thalamic stroke is rare, and only 2 such cases have been described [4, 5], as in most other reports there were additional ocular abnormalities. Here, we describe an isolated unilateral pseudoabducens palsy in a postoperative patient. …