{
  "abstract": "Background Eight-and-a-half syndrome is a clinical triad comprising ipsilateral conjugate horizontal gaze palsy, ipsilateral lower motor neuron (LMN) facial nerve palsy and ipsilateral intranuclear ophthalmoplegia. Common aetiologies include vascular or demyelinating lesions. We present two patients with eight-and-a-half syndrome occurring in the setting of pontine ischæmic strokes.Methods Case Report.Results An 81-year-old female presented with a 4-day history of ataxia, vertigo, diplopia and right facial droop. Examination revealed, impaired rightward conjugate gaze, restricted right eye adduction and left eye abducting nystagmus. Convergence was preserved. Right LMN facial weakness was also present. MRI demonstrated an acute right paramedian dorsal pontine infarct also involving the right facial colliculus.A 73-year-old male awoke with diplopia, ataxia, left facial droop and dysarthria. Examination demonstrated impaired leftward conjugate gaze, left eye adduction failure, right eye abducting nystagmus and left LMN facial weakness. MRI revealed acute left hemipontine infarct with associated involvement of the left facial colliculus.Conclusion Eight-and-a-half syndrome is due to pontine lesions affecting the paramedian pontine reticular formation (PPRF), median longitudinal fasciculus (MLF) causing conjugate gaze palsy and ipsilateral adduction failure (with facial nerve fasciculus involvement resulting in an ipsilateral LMN facial palsy (ie one-and-a-half syndrome plus 7). This should be differentiated from other pontine syndromes including: seven-and-a-half syndrome which comprises intranuclear ophthalmoplegia (the half) and an ipsilateral peripheral facial nerve palsy (cranial nerve 7) and the eponymous Raymond, Millard-Gubler, Gaspirini and Foville syndromes, which although similar, also affect the pyramidal tract fibres, resulting in crossed paralysis in addition to oculomotor manifestations.",
  "authors": [
    {
      "affiliations": [
        "Royal Perth Hospital, Perth, WA, Australia"
      ],
      "name": "Sharanya Shanmugakumar"
    },
    {
      "affiliations": [
        "Royal Perth Hospital, Perth, WA, Australia"
      ],
      "name": "Ian Loke"
    },
    {
      "affiliations": [
        "Fiona Stanley Hospital, Murdoch, WA, Australia"
      ],
      "name": "Jacky Luu"
    },
    {
      "affiliations": [
        "Royal Perth Hospital, Perth, WA, Australia"
      ],
      "name": "Wai Leong"
    },
    {
      "affiliations": [
        "Sir Charles Gairdner Hospital, Perth, WA, Australia"
      ],
      "name": "Daniel Clarke"
    },
    {
      "affiliations": [
        "Royal Perth Hospital, Perth, WA, Australia",
        "Sir Charles Gairdner Hospital, Perth, WA, Australia"
      ],
      "name": "Nicholas Lawn"
    }
  ],
  "title": "3500 Exploring eight-and-a-half syndrome",
  "uid": "ea1d6b77-9cf2-55bd-a57b-f8b6ea08c8be"
}