PMC7332997_01
Position of the patient's eyes in all the gazes at the time of presentation showing significantly restricted ocular movement in upgaze and mild restriction in downgaze
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F1
On motility examination, both eyes showed movement restriction of grade (-4) of upward gaze and (-2) of downward gaze with rotatory nystagmus being present (Figure 1 (Fig. 1)).
MRI scan of the brain showing tiny infarct (white arrow) in the left paramedian rostral upper midbrain at the level of the red nucleus; (A) axial diffusion weighted image showing restricted diffusion in the T2 hyperintensity, and (B) axial T2 fat saturated image showing T2 hyperintense focus
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F2
An urgent MRI scan of the brain suggested features of localized acute infarct in the left paramedian rostral and dorsal part of the upper midbrain at the level of the red nucleus (Figure 2 (Fig. 2)).
At 2 weeks post-treatment, position of the patient's eyes in all the gazes showing complete ocular movement
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F3
At 2 weeks review, a complete symptomatic as well as clinical improvement was noted (Figure 3 (Fig. 3)).