Isolated bilateral vertical gaze palsy is an unusual presentation in acute settings. It is usually accompanied by subtle signs that can lead to precise anatomic localization. This case is notable for the rare co-occurrence of bilateral vertical gaze palsy, Collier’s sign, and contralesional pseudo-abducens paresis with a unilateral dorsomedial thalamic infarct, highlighting the complexity of vertical gaze and convergence pathways.
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