Abstract A 53-year-old man was admitted with diplopia, right ptosis, left lid retraction, mild left sided weakness and involuntary movements. Neurological examination revealed plus–minus lid and Benedikt's syndromes together. Magnetic resonance imaging (MRI) showed two distinct mesencephalic infarctions in territories of paramedian and pedincular perforating arteries. Magnetic resonance angiography (MRA) showed severe stenosis of proximal segment of the right posterior cerebral artery (PCA). Rare clinical presentations such as Benedikt and plus–minus syndromes can be seen together and be due to stenosis of the posterior cerebral artery with specific regional infarctions.