Abstract
BackgroundIn the list of named numerical neuro-ophthalmological syndromes, such as one-and-a-half syndrome and others, we report for the first time twenty-and-a-half syndrome, which is characterized by one-and-a-half syndrome with bilateral seventh and right fifth nerve palsy (1.5 + 7 + 7 + 5 = 20.5) in a patient with ischemic stroke.Case presentationA 45-year-old Asian Hindu woman presented with vomiting and imbalance of 1 day’s duration. She had left-sided ataxic hemiparesis with one-and-a-half syndrome with bilateral seventh and right fifth nerve palsy. Magnetic resonance imaging of her brain revealed acute non-hemorrhagic infarct in the right posterolateral aspect of pons and medulla, with normal brain vessels angiography. We described her disorder as twenty-and-a-half syndrome. She was put on antiplatelet therapy.ConclusionsTwenty-and-a-half syndrome is reported for the first time. It is due to posterior circulation stroke; in our case, it was due to lacunar infarcts in the pons and medulla, manifesting as one-and-a-half syndrome with bilateral seventh and right fifth nerve palsy.
Highlights
In the list of named numerical neuro-ophthalmological syndromes, such as one-and-a-half syndrome and others, we report for the first time twenty-and-a-half syndrome, which is characterized by one-and-a-half syndrome with bilateral seventh and right fifth nerve palsy (1.5 + 7 + 7 + 5 = 20.5) in a patient with ischemic stroke
The involvement of a facial nerve with one-and-a-half syndrome was termed eight-anda-half syndrome by Eggen-Berger who first reported three such cases. In continuation of this concept, we report a new neuro-ophthalmological syndrome, twenty-and-a-half syndrome, comprising one-and-a-half syndrome with
We described a patient with right horizontal gaze and right eye adduction restriction with horizontal nystagmus on abduction of left eye suggestive of right internuclear ophthalmoplegia (INO), absent bilateral corneal reflex, and decreased sensation over right half of her face suggesting right fifth cranial nerve palsy along with bilateral lower motor neuron (LMN)-type facial nerve palsy suggestive of bilateral LMN-type seventh cranial nerve palsy with etiology being ischemic posterior circulation stroke due to small vessel disease (SVD) of the brain
Summary
Twenty-and-a-half syndrome is reported for the first time. It is due to posterior circulation stroke; in our case, it was due to lacunar infarcts in the pons and medulla, manifesting as one-and-a-half syndrome with bilateral seventh and right fifth nerve palsy.
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