The vascular supply of this small brainstem structure is complex. Although midbrain infarcts and particularly hemorrhages are uncommon, their clinical manifestations are diverse mainly because the vertical gaze centers and two of three nuclei of the extraocular muscles lie primarily in the midbrain. Consequently, eye movement disturbances are often the hallmark clinical findings in midbrain stroke. The main clinical patterns, etiology and outcome of infarcts limited to the midbrain are summarized according to defined vascular territories along with the clinical findings of midbrain hemorrhage.