We report a case of a patient who presented with ipsilateral oculomotor nerve palsy after a spontaneous left temporoparietal lobar hemorrhage with mass effect. Primary symptomatology included ipsilateral ptosis, dilated fixed pupil, and a lack of superior and medial movement with limited inferior left eye movements. Brain imaging revealed compression of the left upper midbrain due to subtentorial herniation of the hemorrhage, and susceptibility-weighted images sequences showed cerebral microbleed in the left midbrain substantia nigra.
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