Paramedian thalamic infarction with transient pseudoabducens palsy: a case report

Abstract

A 78-year-old man acutely developed diplopia and left hemiplegia. Neurological examinations revealed limited abduction of the right eye with intermittent spontaneous abducting jerks. The left eye was slightly hyperabducted at the primary position and upward gaze was also slightly limited. When the left eye was covered, the right eye could abduct almost normally. An ischemic lesion was detected in the right paramedian thalamic region but not in the pons on magnetic resonance imaging. Therefore, this failure of ocular abduction is regarded as ‘pseudoabducens palsy.’ Within 7 days, the neurological findings resolved completely. Pseudoabducens palsy can occur by thalamic lesion and might easily be overlooked because of its transient duration.