Eight-and-a-half syndrome caused by a pontine haemorrhage: a case report and review of the literature

Chen, Yanyan; Li, Jia; Chen, Xi; Ye, Zusen; Zhu, Zhenguo

doi:10.1080/00207454.2017.1418344

Cited by 15 publications

(9 citation statements)

References 24 publications

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“…Rarely when the lesion extends to the ipsilateral facial nerve nucleus or its fascicles, which wrap around the abducens nucleus, does it result in ipsilateral lower motor neuron facial nerve palsy. The combination of both one-and-a-half syndrome (1.5) and lower motor neuron facial nerve palsy (7) is therefore termed as eight-and-a-half syndrome [ 5 ] (8.5). This syndrome localizes lesions to pontine tegmentum (as shown in Fig.…”

Section: Discussionmentioning

confidence: 99%

Eight-and-a-half syndrome as the first presentation of multiple sclerosis in an Asian male: a case report

et al. 2023

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Background Multiple sclerosis is a diffuse chronic demyelinating disease of the central nervous system. It is relatively uncommon in the Asian population and even more so in males. Despite the usual involvement of the brainstem, eight-and-a-half syndrome remains a rare first presentation in multiple sclerosis. Only a few cases have been reported previously, but none involving the Asian population. Eight-and-a-half syndrome, a neuro-ophthalmological condition, is characterized by one-and-a-half syndrome with ipsilateral lower facial nerve palsy, which localizes lesions to the pontine tegmentum. This case report demonstrates the first case of eight-and-a-half syndrome as the first presentation of multiple sclerosis in an Asian male. Case presentation A healthy 23-year-old Asian man presented with sudden onset of diplopia followed by left-sided facial asymmetry for 3 days. Assessment of extraocular movement revealed left conjugate horizontal gaze palsy. On right gaze, there was limited left eye adduction and horizontal nystagmus of the right eye. These findings were consistent with a left-sided one-and-a-half syndrome. Prism cover test revealed left esotropia of 30 prism diopters. Cranial nerve examination showed left lower motor neuron facial nerve palsy, while other neurological examination was normal. Magnetic resonance imaging brain showed multifocal T2 fluid attenuated inversion recovery hyperintense lesions, involving bilateral periventricular, juxtacortical, and infratentorial regions. A focal gadolinium contrast-enhanced lesion with open ring sign on T1 sequence was seen at the left frontal juxtacortical region. Multiple sclerosis was diagnosed on the basis of the clinical and radiological evidence, which fulfilled the 2017 McDonald criteria. Positive oligoclonal bands in cerebrospinal fluid analysis further confirmed our diagnosis. He had a complete resolution of symptoms 1 month after a course of pulsed corticosteroid therapy, and was subsequently placed on maintenance therapy with interferon beta-1a. Conclusion This case illustrates eight-and-a-half syndrome as the first presentation of a diffuse central nervous system pathology. A wide range of differential diagnoses needs to be considered in such a presentation as based on the patient’s demographics and risk factors.

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Section: Discussionmentioning

confidence: 99%

Eight-and-a-half syndrome as the first presentation of multiple sclerosis in an Asian male: a case report

et al. 2023

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“…It is characterized by one-anda-half syndrome (internuclear ophthalmoplegia in addition to horizontal gaze palsy) and an ipsilateral cranial nerve VII palsy (lower motor neuron-type). The affected nuclei may include either a combination of the ipsilateral seventh and sixth nerve nucleus and the ipsilateral MLF or a combination of ipsilateral seventh and ipsilateral PPRF along with the ipsilateral MLF [6].…”

Section: Discussionmentioning

confidence: 99%

Complete Bilateral Horizontal Gaze Palsy as Initial Manifestation of Multiple Sclerosis: A Case Report Corresponding Author*

ALakkad¹,

Gamea

Ibraheem

2022

Preprint

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Multiple sclerosis is a chronic inflammatory disease of central nervous system that commonly affects young adults. Although ocular movement disturbances are commonly encountered in multiple sclerosis, bilateral horizontal gaze palsy is quite rare. We present a case of young woman presented with dizziness, intractable vomiting and visual disturbances for one week, on examination found to have complete bilateral horizontal gaze palsy while vertical gaze was intact. Brain MRI showed a small lesion in posterior part of medial pontine tegmentum bilaterally which was responsible for patient`s symptoms. She received five doses of one-gram methylprednisolone, her symptoms gradually improved over one week after treatment.

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“…EHS is a rare brainstem syndrome which localizes to the caudal tegmental region of the pons, and is defined by the combination of a seventh cranial nerve palsy and an ipsilateral one-and-a-half syndrome [3,5]. To best of our knowledge, this is the first case describing an EHS as the initial clinical presentation of brain metastases of any organ.…”

Section: Discussionmentioning

confidence: 99%

Eight-and-a-Half Syndrome as The First Presentation of Unknown Metastatic Primary Tumor

Silva

2021

AJBSR

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Eight-and-a-half syndrome caused by a pontine haemorrhage: a case report and review of the literature

Abstract: Recognition of the spectrum of eight-and-a-half syndrome allows precise anatomic localization of the lesion to pontine tegmentum region.

Cited by 15 publications

References 24 publications

Eight-and-a-half syndrome as the first presentation of multiple sclerosis in an Asian male: a case report

Eight-and-a-half syndrome as the first presentation of multiple sclerosis in an Asian male: a case report

Complete Bilateral Horizontal Gaze Palsy as Initial Manifestation of Multiple Sclerosis: A Case Report Corresponding Author*

Eight-and-a-Half Syndrome as The First Presentation of Unknown Metastatic Primary Tumor

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