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Background: Conventional magnetic resonance imaging may fail to identify very small but clinically relevant acute subcortical brain infarcts. Diffusion-weighted magnetic resonance imaging (DWI) is very sensitive and specific for acute cerebral ischemia and should contribute to the early detection of such lesions. Methods: We analyzed 6 patients who presented with acute vertical gaze palsy and in whom DWI was performed within 1–6 days from symptom onset. Results: DWI accurately identified ischemia in an area supplied by the posterior thalamosubthalamic paramedian artery in all patients. T₂-weighted and FLAIR imaging failed to identify the clinically relevant lesion in 2 and 3 patients, respectively. Conclusion: DWI improves the clinicoanatomical correlation in patients presenting with supranuclear oculomotor disturbances.

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