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Images in Neurology |

Eight-and-a-Half Syndrome

Jone Bocos-Portillo, MD1; Javier Ruiz Ojeda, MD1; Marian Gomez-Beldarrain, MD1; Raquel Vazquez-Picon, MD1; Juan Carlos Garcia-Monco, MD1
[+] Author Affiliations
1Hospital Galdakao-Usansolo, Galdakao, Vizcaya, Spain
JAMA Neurol. 2015;72(7):830. doi:10.1001/jamaneurol.2015.0255.
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An 81-year-old patient was seen with sudden onset of ophthalmoplegia and unsteadiness. His medical record included hypertension, type 2 diabetes mellitus, and hypercholesterolemia. The neurological examination disclosed left internuclear ophthalmoplegia and horizontal left-sided gaze palsy, accompanied by left-sided peripheral facial palsy (Video). The physical examination findings were otherwise normal.

Article Information

Accepted for Publication: February 14, 2015.

Corresponding Author: Juan Carlos Garcia-Monco, MD, Hospital Galdakao-Usansolo, 48960 Galdakao, Vizcaya, Spain (hospit05@sarenet.es).

Published Online: May 11, 2015. doi:10.1001/jamaneurol.2015.0255.

Conflict of Interest Disclosures: None reported.

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Location of the Lesion Responsible for Eight-and-a-Half Syndrome and Magnetic Resonance Imaging

A, Shown is the anatomical location of the lesion responsible for eight-and-a-half syndrome (round shadow). Involvement of the left abducens center explains the left horizontal gaze paresis, while the lesion at the left medial longitudinal fasciculus (MLF) results in an internuclear ophthalmoplegia when attempting a right gaze (the left eye cannot adduct, and the right eye shows horizontal nystagmus). This clinical combination is known as one-and-a-half syndrome, and additional involvement of the facial nerve genu explains the ipsilateral facial palsy, resulting in eight-and-a-half syndrome. Modified from Fitzgerald et al.2 B and C, Brain magnetic resonance imaging (diffusion-weighted sequences) showed an ischemic stroke involving the dorsal tegmentum of the pons.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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Video Recording of the Patient

The video shows the patient’s ophthalmoplegia and facial palsy.

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