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    Eight-and-a-Half Syndrome

    By Jessica Shantha, MD, and Jill Wells, MD, and photographed by Debora Jordan, Emory University, Atlanta
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    Eight and a Half Syndrome

    A 58-year-old African-American woman presented with blurry vision and foreign body sensation in the left eye. She had been recently hospitalized with a hemorrhagic pontine stroke secondary to uncontrolled hypertension. On examination, her visual acuity was 20/60 in the right eye and counting fingers in the left. She was unable to close her left eye. As a result, she had developed a large corneal epithelial defect.

    Motility exam showed a left gaze palsy and left eye limitation of adduction. One-and-a-half syndrome refers to horizontal gaze palsy (one) with internuclear ophthalmoplegia (half) due to a lesion of the paramedian pontine reticular formation and medial longitudinal fasciculus. When cranial nerve VII is affected, as in this case secondary to involvement of the facial nerve colliculus, the result is eight-and-a-half syndrome (referring to CN VII plus one-and-a-half).

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