Originally presented during Pediatric Ophthalmology Subspecialty Day 2015, David Hunter discusses the case of a 53-year-old woman with a chief complaint of double vision. Three years ago she developed meningoencephalitis that progressed slowly over a year. The inflammation involved the brain stem and cerebellum. This was followed one year later by a cerebrovascular accident with left-sided hemi paresis. Her husband reports that her eyes were fixed in various directions of gaze at different times. She has now recovered much of her strength, but is still wheelchair-bound with left-sided weakness.