Vertical one-and-a-half syndrome with contralesional pseudo-abducens palsy in a patient with thalamomesencephalic stroke

We report a unique neuroophthalmological syndrome consisting of vertical one-and-a-half syndrome-resulting from a combination of supranuclear conjugate upgaze palsy associated with left infranuclear (fascicular) third nerve involvement (Weber syndrome)-with concomitant contralesional pseudo-abducens palsy. Magnetic resonance imaging confirmed that this unusual clinical combination was the result of two infarcts one in the left thalamomesencephalic junction and another affecting the left infrategmental paramedian area of the rostral midbrain. We discuss the clinical topography of both neuroophthalmological findings. This unusual neuroophthalmological finding has not been reported.