A case of left vertebral artery dissection after neck manipulation associated with an ipsilateral thalamo-peduncular infarct by distal embolism is reported. The oculomotor signs observed are explained for the left eye by an intra-axial third nerve lesion, and for the right eye by a limitation of the horizontal gaze to the right and an upgaze palsy of supranuclear origin. The association of infra and supranuclear lesions without nuclear lesion in thalamo-peduncular infarcts is considered.