FP1424 : Eight-and-a half syndrome – An unusual presentation of pontine infarction.

Dr.Yash Gala, G21215

Case Report : This is a case of a 40y/M who presented to casualty with features of sudden onset Lt sided upper limb & lower limb weakness with deviation of angle of mouth to the left side, slurring of speech and double vision on left gaze.Examination revealed a right sided facial weakness with contralateral hemiparesis indicative of an acute vascular stroke.Detailed ophthalmic evaluation showed that the ocular position of the right eye was fixed at the midline in forward gaze and the left eye in abduction.On leftward gaze the left eye was abducted with monocular nystagmus suggestive of One and a half syndrome.This along with the involvement of the seventh nerve clinched the diagnosis, confirmed on neuroimaging studies.

Conclusion :The interpretation of eye movement abnormalities in brainstem strokes can be difficult. Internuclear ophthalmoplegia is a discreet and informative sign whose clinical recognition is essential for an accurate topographical diagnosis.