Faculty, Staff and Student Publications

Language

English

Publication Date

1-1-2025

Journal

Journal of Investigative Medicine High Impact Case Reports

DOI

10.1177/23247096251363013

PMID

40817674

PMCID

PMC12357991

PubMedCentral® Posted Date

8-16-2025

PubMedCentral® Full Text Version

Post-print

Abstract

Eight-and-a-half syndrome is a rare neuro-ophthalmic syndrome characterized by conjugate horizontal gaze palsy, ipsilateral internuclear ophthalmoplegia, and ipsilateral facial nerve palsy. It results from a lesion affecting the paramedian pontine reticular formation, the medial longitudinal fasciculus, and the abducens nucleus of the same side, at the level of the lower pons. We present a case of a 49-year-old man with 2-week diplopia and 3-day right-sided facial droop, drooling, and dysarthria. CT angiography of the head and neck revealed atherosclerotic disease, with decreased caliber of the basilar artery at the level of the pons. Brain MRI showed a subacute ischemic lesion in the right dorsal pons. The prognosis is favorable with improvement of facial palsy and ocular symptoms. In addition to treating the underlying etiology, neurorehabilitation is indicated. This case highlights the importance of identifying the level of the lesion in patients with gaze palsy and facial droop, as well as correlating the findings into syndromic diagnoses.

Keywords

Humans, Male, Middle Aged, Ischemic Stroke, Facial Paralysis, Magnetic Resonance Imaging, Diplopia, Dysarthria, Ocular Motility Disorders, Syndrome, Pons, Computed Tomography Angiography

Published Open-Access

yes

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