An Interesting Case of Eight and a Half Syndrome
Dr. Hassan Kazia, Emergency Medicine & Dr. Saeed Taghizadeh, Consultant Neurologist
Prime Hospital, Dubai, UAE
Background and Rationale:
We present an interesting case of a 49-year-old man who was admitted with right sided weakness and visual disturbance.
49-year-old man presented to his local hospital with right sided facial droop, visual disturbance and feeling unsteady while walking. He had a past medical history of type 2 diabetes mellitus. On examination he was noted to have impaired horizontal eye movement on both sides in right eye and impaired adduction of left eye with nystagmus on abduction and lower motor neuron facial nerve weakness on right side. He also had paraesthesia on the left upper and lower limbs. There were no cerebellar signs or any limb weakness.
Initial CT brain scan was normal. He subsequently had a MRI brain scan which was normal too. He was transferred from his local hospital to our hospital for further investigation and management. He was reviewed by the neurologist and was given a clinical diagnosis of probable pontine ischaemic stroke. A repeat MRI scan was requested which showed acute pontine infarct which confirmed the diagnosis. The ophthalmoplegia (one and a half syndrome) along with ipsilateral lower motor neuron facial nerve weakness fits with a diagnosis of eight and a half syndrome.
Eight and a half syndrome is a combination of one and a half syndrome and lower motor neuron facial nerve palsy. It can be easily missed if we are not aware of this rare syndrome. Being aware of this syndrome will help us in localizing the lesion and also in diagnosing it. In our case the initial MRI was reported as normal. It’s good practice to review the old scans again or repeat the scan if there is high clinical index of suspicion.