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Rare occurrence of eight-and-a-half syndrome as a clinically isolated syndrome
  1. Sneha Jacob1,
  2. Ann Murray2
  1. 1Department of Neurology, West Virginia University Health Sciences Center, Morgantown, West Virginia, USA
  2. 2Department of Neurology, West Virginia University Health Sciences Center, Morgantown, West Virginia, USA
  1. Correspondence to Dr Sneha Jacob, snjacob{at}


Eight-and-a-half syndrome is a rare condition that is described as a combination of one-and-a-half syndrome and an ipsilateral facial nucleus lesion. We present a clinical case of occurrence of eight-and-a-half syndrome that was caused by a demyelinating lesion in the dorsal pontine tegmentum. A 44-year-old man presented to the hospital with a subacute onset of horizontal diplopia and left-sided facial weakness. MRI revealed a T2 hyperintense lesion in his dorsal pons, which was consistent with a demyelinating pathology. Treatment with intravenous steroids showed significant improvement in his symptoms. In our case, it occurred due to a suspected demyelinating lesion that was this patient’s first and only demyelinating event, leaving him with a diagnosis of clinically isolated syndrome. His responsiveness to steroids represents the first case report of an adult patient presenting with an eight-and-a-half syndrome secondary to a suspected demyelinating pathology.

  • brain stem / cerebellum
  • cranial nerves
  • multiple sclerosis
  • neuroimaging

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  • SJ and AM contributed equally.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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