Eight-and-a-Half Syndrome Presented with Trigeminal Neuralgia

Abdulkadir Koçer

doi:10.24983/scitemed.acri.2018.00088

Abstract

Most isolated syndromes of Eight-and-a-Half Syndrome are associated with vascular etiology. Symptomatic trigeminal neuralgia due to infarction is rare. The author reports a patient with left-sided facial pain. It was followed by one-and-a-half syndrome with facial nerve palsy during the next day. Diffusion-weighted magnetic resonance imaging of his head revealed restricted diffusion in the left inferior pontine tegmentum neighboring the fourth ventricle extending ventrally. This case is the first report of Eight-and-a-Half Syndrome presented with recurrent attacks of unilateral facial pain, fulfilling criteria for classical trigeminal neuralgia.

Highlights

Eight-and-a-half syndrome (EHS) is the combination of one-and-a-half syndromes, which results from injury to either the medial longitudinal fasciculus (MLF) and abducens nerve nucleus or MLF plus the paramedian pontine reticular formation and ipsilateral facial nucleus [1,2]
Trigeminal neuralgia (TN) is most commonly caused by vascular compression of the trigeminal nerve root entry zone
It is believed that TN is due to an irritation at the trigeminal nucleus [4]

Summary

Introduction

Eight-and-a-half syndrome (EHS) is the combination of one-and-a-half syndromes, which results from injury to either the medial longitudinal fasciculus (MLF) and abducens nerve nucleus or MLF plus the paramedian pontine reticular formation and ipsilateral facial nucleus [1,2] This syndrome is diagnosed clinically, but pontine lesions of a few millimeters of the dorsal pontine tegmentum are characterized radiographically [1,2]. The pain was in his left temple presenting typical trigeminal neuralgia over the second and third branches of the nerve and not extending into the left ear He had gone to a neurologist and he had a history of one gabapentin 600 mg tablet use followed by facial weakness and diplopia within the same day. Cranial MRI and carotid and vertebral-basilar system computed tomography angiography exams were normal It was accepted as a small vessel infarction and the treatment with anti-aggregating (acetylsalicyclic acid 300 mg), anti-hypertensive, and anti-lipidemic agents was started.

Discussion

Summary and Conclusion