Magnetic Resonance Imaging Finding in Divergence Paralysis

A 72-year-old woman with hyperlipidaemia was complaining of horizontal diplopia only at far viewing for 7 months. There were no neurological abnormalities other than divergence paralysis and concomitant skew deviation. Cranial magnetic resonance imaging demonstrated an old infarction in the vicinity of the periaqueductal gray matter on the left side. The precise location of the divergence centre of the eyes remains uncertain, because the responsible lesions for divergence paralysis are rarely identified by neuroimaging. This case suggests that the divergence centre may be located in the vicinity of the periaqueductal gray matter.