An unusual presentation of hemiparesis with complex ophthalmoplegia: A ‘nine’ syndrome

Abstract

Nine syndrome is a rare clinical entity with core clinical signs of one and a half syndrome, ipsilateral facial palsy, and contralateral hemiparesis/hemianesthesia and localizing to the dorsal paramedian pontine tegmentum. The awareness of this sign helps in precise localization and consideration of relevant aetiologies. Here, we report a case consisting of right horizontal gaze palsy with right internuclear opthalmoplegia and right lower motor neuron type VII nerve palsy constituting eight-and-a-half syndrome. With the additional involvement of left upper and lower limb upper motor neuron weakness, it revealed the lesion responsible for the ‘nine’ syndrome in magnetic resonance imaging of the brain. It is our purpose to highlight the genesis of this combination of clinical signs.