Bengal Physician Journal

Register      Login

VOLUME 8 , ISSUE 3 ( September-December, 2021 ) > List of Articles

Pictorial CME

Eight-and-a-half Syndrome—A Rare Pontine Neuro-ophthalmological Syndrome

Kamatchi Sundaramoorthy, Murali Kamalakannan, Swamy Kondapalli, Sakthivelayutham Saravanan, Sowmini Padmaja Raman, Malcolm Jeyaraj Krishnamoorthy, Sathish Kumar Mallikarjuna, Viveka Saravanan Raju

Keywords : Eight-and-half syndrome, Internuclear ophthalmoplegia, Paramedian pontine reticular formation

Citation Information : Sundaramoorthy K, Kamalakannan M, Kondapalli S, Saravanan S, Raman SP, Krishnamoorthy MJ, Mallikarjuna SK, Raju VS. Eight-and-a-half Syndrome—A Rare Pontine Neuro-ophthalmological Syndrome. Bengal Physician Journal 2021; 8 (3):81-83.

DOI: 10.5005/jp-journals-10070-7062

License: CC BY-NC 4.0

Published Online: 23-12-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Abstract

The combination of one-and-a-half syndrome and facial nerve palsy is a rare neurological syndrome called eight-and-a-half syndrome, described first by Eggenberger in 1998. The one-and-a-half syndrome is characterized by ipsilateral conjugate horizontal gaze palsy (the “one”) and an ipsilateral internuclear ophthalmoplegia (the “one-half”). A single unilateral lesion involving the paramedian pontine reticular formation or the abducens nucleus (causing the conjugate gaze palsy) with the interruption of internuclear fibers of the ipsilateral medial longitudinal fasciculus along with the region of facial colliculus results in eight-and-a-half syndrome. The occlusion of perforating artery to the pons resulting in pontine infarction is the commonest cause of this syndrome. The rare causes include demyelination, tumor, infection, and brainstem vasculitis. We describe here a case of eight-and-a half syndrome in a 50-year old gentleman due to pontine infarct, who also had cerebrovascular disease risk factors.


HTML PDF Share
  1. Eggenberger E. Eight-and-a-half Syndrome. Journal of Neuro-Ophthalmology [Internet]. Ovid Technologies (Wolters Kluwer Health); 1998 Jun;18(2):114–116. Available from: http://dx.doi.org/10.1097/00041327-199806000-00008
  2. Singh S, Sugantharaj V, Kumar MR, et al. A Rare Case of Eight-and-a-half Syndrome: A Case Report. 2021;4(3):71–73. DOI: 10.5005/jp-journals-10082-03122.
  3. Skaat A, Huna-Baron R. Eight-and-a-half syndrome: a rare neuro-ophthalmologic syndrome. Arch Neurol 2012;69(7):934–935. DOI: 10.1001/archneurol.2011.2185.
  4. Mortoz P, Nordling MM, Sorensen TL. Eight-and-a-half syndrome as presenting sign of childhood multiple sclerosis. J AAPOS 2014;18(5):490–492. DOI: 10.1016/j.jaapos.2014.05.007.
  5. Van Toorn R, Schoeman JF, Donald PR. Brainstem tuberculoma presenting as eight-and-a-half syndrome. Eur J Paediatr Neurol 2006;10(1):41–44. DOI: 10.1016/j.ejpn.2005.11.003.
  6. Bodur M, Toker RT, Özmen AH, Okan MS. Facial colliculus syndrome due to a Herpes simplex virus infection following Herpes labialis. Turk J Pediatr. 2021;63(4):727–730. DOI: 10.24953/turkjped.2021.04.023. PMID: 34449158.
  7. Kakar P, Brown Z, Banerjee S. Eight-and-a-half syndrome: an unusual presentation of brainstem infarction. QJM [Internet]. Oxford University Press (OUP); 2011 Oct 19;106(3):273–6. Available from: http://dx.doi.org/10.1093/qjmed/hcr187
  8. Sandeep Reddy Nareddy, E.A. Ashok Kumar. A rare case of eight and a half syndrome due to pontine hemorrhage - A case report. IAIM, 2020;7(7):42–48. Available from: http://iaimjournal.com/
  9. Jens W, Ahmed A (2015) Eight and a Half Syndrome from Multiple Sclerosis. J Neurol Stroke 3(4):00099. DOI: 10.15406/jnsk.2015.03.00099.
  10. Costa e Silva M, Mota C, Silva E, Barroso A. Eight-and-a-half Syndrome as The First Presentation of Unknown Metastatic Primary Tumor. Am J Biomed Sci & Res 2021;13(6). AJBSR.MS.ID.001925. DOI: 10.34297/AJBSR.2021.13.001925.
  11. Koçer A. Eight-and-a-Half Syndrome Presented with Trigeminal Neuralgia. Annals of Case Reports and Images [Internet]. SciTeMed Publishing Group; 2018;1(2). Available from: http://dx.doi.org/10.24983/scitemed.acri.2018.00088
  12. Xue, F, Zhang, L., Zhang, L., et al. (2017). One-and-a-half syndrome with its spectrum disorders. Quantitative imaging in medicine and surgery, 7(6):691–697. Available from: https://doi.org/10.21037/qims. 2017.12.04
  13. Nandhagopal R, Krishnamoorthy SG. Neurological picture. Eight-and-a-half syndrome. J Neurol Neurosurg Psychiatry 2006;77(4):463. DOI: 10.1136/jnnp.2005.078915.
  14. Mesina BVQ, Sosuan GMN, Reyes KB. Eight-and-a-half syndrome: a rare potentially life-threatening disease. GMS Ophthalmol Cases 2018;8(8):Doc04. DOI: 10.3205/oc000086. PMID: 29977730; PMCID: PMC6008505.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.