A 31-year-old man demonstrating acquired bilateral gaze palsy as an isolated symptom of a paramedian pontine reticular formation (PPRF) lesion due to a ruptured cryptic cavernous hemangioma is herein reported. MRI revealed a flow void surrounded by a hemorrhagic lesion, which was located in the lower dorsal part of the pons. This lesion corresponded to the PPRF. His eye movement almost completely recovered and MRI revealed the absorption of the hematoma 2 months later, with only conservative observation. This is a rare case presenting most likely with a minimal lesion for bilateral gaze palsy. Based on the above findings it is thus concluded that surgical removal of such a cryptic cavernous hemangioma should therefore not be the only choice.