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The affected eye is the left eye shows impairment of adduction. When an attempt is made to gaze contralaterally (relative to the affected eye), the affected eye adducts minimally, if at all. The contralateral eye abducts, however with nystagmus. Additionally, the divergence of the eyes leads to horizontal diplopia convergence is generally preserved. MRI brain shows acute infarct in the region of left medial longitudinal bundle. The disorder is caused by dysfunction of the medial longitudinal fasciculus (connecting the paramedian pontine reticular formation-abducens nucleus complex of the contralateral side to the oculomotor nucleus of the ipsilateral side. It is seen bilaterally in multiple sclerosis, vasculitis and also in Arnold-Chiari malformation, neurosyphilis, Lyme disease, tumor, head trauma, nutritional disorders, like, Wernicke encephalopathy, pernicious anemia, or drug intoxication like, tricyclic antidepressants or opioids.