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Table of Contents    
NEUROIMAGES
Year : 2019  |  Volume : 67  |  Issue : 2  |  Page : 611-612

Eight-and-a-half syndrome: A rare neuro-ophthalmologic syndrome of pontine infarction


Department of Neurology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India

Date of Web Publication13-May-2019

Correspondence Address:
Dr. Jaslovleen Kaur
Department of Neurology, Dayanand Medical College and Hospital, Tagore Lines, Ludhiana - 141 001, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.257993

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How to cite this article:
Kaur J, Paul BS, Singh G. Eight-and-a-half syndrome: A rare neuro-ophthalmologic syndrome of pontine infarction. Neurol India 2019;67:611-2

How to cite this URL:
Kaur J, Paul BS, Singh G. Eight-and-a-half syndrome: A rare neuro-ophthalmologic syndrome of pontine infarction. Neurol India [serial online] 2019 [cited 2019 May 22];67:611-2. Available from: http://www.neurologyindia.com/text.asp?2019/67/2/611/257993




Eight-and-a-half syndrome includes ipsilateral VIth and VIIth nerve palsy, inter-nuclear ophthalmoplegia, and ipsilateral gaze paralysis.[1] The most common etiologies are brain stem infarcts/hemorrhage, multiple sclerosis/brainstem demyelination, brain stem tumors, and arteriovenous malformations.[2] We report a case of a 55-year old female patient who presented with an eight-and-a-half syndrome due to lacunar pontine infarction.

A 55-year old female patient with a history of uncontrolled diabetes mellitus presented with a 2-day history of sudden onset vomiting followed by blurring of vision and abnormal sensation on the left side of the face. Examination revealed loss of nasolabial fold and reduced left palpebral fissure, suggesting a left lower motor neuron type VIIth nerve weakness. Further eye examination suggested a total left horizontal gaze paresis with partial right horizontal gaze paresis with limitation of adduction of the right eye suggestive of horizontal one-and-a-half syndrome. Vertical ocular movements from the primary position were normal [Figure 1].
Figure 1: (a) Conjugate left horizontal gaze palsy. (b) on right horizontal gaze, the patient had impaired left adduction and retained right abduction, which evoked right lateral nystagmus. (c) Bilateral retained downward gaze. (d) Left lower motor neuron type facial palsy with Bell's phenomenon. (e) Bilateral retained upward gaze

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Her initial investigations, complete blood profile, serum electrolytes, and liver profile were normal. Cranial magnetic resonance imaging (MRI) showed a left paramedian tegmental pontine lesion. Magnetic resonance angiography of the intracranial vasculature was normal. The infarct was thus localized to the lower pontine tegmental area due to occlusion of the right paramedian pontine perforators [Figure 2].
Figure 2: MRI brain, diffusion weighted image, showing acute infarct in the left dorsal pons

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We present this case to put forward the fact that eye movement abnormalities can have interesting presentations with lacunar infarcts being one of the rare causes.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Sarwal A, Garewal M, Sahota S, Sivaraman M. Eight-and-a-half syndrome. J Neuroimaging 2009;19:288-90.  Back to cited text no. 1
    
2.
Felicio AC, Bichuetti DB, Marin LF. Bilateral horizontal gaze palsy with unilateral peripheral facial paralysis caused by pontine tegmentum infarction. J Stroke Cerebrovasc Dis 2009;18:244-6.  Back to cited text no. 2
    


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