Isolated sixth nerve palsy from pontine infarct

Isolated sixth nerve palsy associated with pontine infarct is very rare due to close anatomic organization of the structures. A 62-year-old woman, who complained of diplopia, had a diagnosis of sixth nerve palsy. Ophthalmolog ical examination revealed 30 PD left esotropia in primary position with lim ited abduction of the left eye. Neurologic examination was normal. MR showe d a lacunar infarct in the pens consistent with a fascicular lesion. Cerebr al angiography was normal. Pontine infarcts causing fascicular lesions shou ld be kept in mind in isolated sixth nerve palsies.