Article Text
Summary
A man aged 51 years presented with sudden onset, horizontal, binocular, double vision and right facial weakness. Ocular motility examination demonstrated a right horizontal gaze palsy pattern in keeping with a one-and-a-half syndrome. Since this was associated with a concomitant, ipsilateral, lower motor neuron (LMN) facial (VIIth) cranial nerve palsy, he had acquired an eight-and-a-half syndrome. Diffusion-weighted MRI confirmed a small infarcted area in the pons of the brainstem which correlated with anatomical location of the horizontal gaze centre and VIIth cranial nerve fasciculus. As a result of this presentation, further investigations uncovered a hitherto undiagnosed blood dyscrasia—namely polycythaemia vera. Regular venesection was started which resulted in complete resolution of his ocular motility dysfunction and an improvement of his LMN facial nerve palsy.
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Footnotes
Contributors ER is responsible for clinical involvement in direct patient care and follow-up, as well as principal author of the manuscript. MPD is responsible for obtaining test results and writing/review of parts of the manuscript. GH is responsible for writing/review of parts of the manuscript and analysis of neuroimaging.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.