Eight-and-A-Half Syndrome: A Rare Case Report

Dr. Dhruvi Alpeshkumar Brahmbhatt | Dr. Ashish Sindhi

Abstract: Background: 1) Eight-and-a-half syndrome describes a constellation of symptoms that occur due a lesion involving the abducens (CN ) nucleus, the fascicular portion of the facial (CN VII) nerve and the medial longitudinal fasciculus (MLF). 2) It results in a combination of horizontal gaze palsy, facial nerve palsy, and internuclear ophthalmoplegia (INO). 3) It is usually caused by demyelination, infarct, tumors and occasionally by haemorrhage. Case Presentation: 1) A 58 year old female known to have hypertension presented with deviation of angle of mouth towards right side, inability to close left eye lid and slurring of speech since 3 days. 2) On examination of extraocular movement, left conjugate horizontal gaze palsy with limited right abduction and horizontal nystagmus of right eye was seen which were suggestive of left sided One-and-a-half syndrome. 3) Cranial nerve examination showed left lower motor neuron facial nerve palsy. Rest neurological examination was normal. 4) Magnetic resonance imaging of brain showed left frontal, thalamic and pontine small foci of acute infarcts and left thalamic chronic haemorrhage. 5) Patient was treated with antihypertensives, antiplatelets and artificial eye drops. Conclusion: The rare diagnosis of Eight-and-a-half syndrome requires high degree of clinical suspicion when comorbid eye movement limitation and peripheral facial paralysis are seen followed by thorough clinical examination for identifying precise location of the lesion and to determine proper treatment regime for the patient.

Keywords: Eight-and-a-half, abducens nucleus, facial nerve, internuclear ophthalmoplegia

Edition: Volume 12 Issue 11, November 2023,

Pages: 985 - 987