Motor Neuron Facial Palsy Research Articles

Lower Motor Neuron Facial Nerve Paralysis Following Recombinant Hepatitis B Vaccine Administration: A Case Report and Literature Review.

The Hepatitis B vaccine's safety profile is considered safe, but sometimes neurological complications, like Bell's palsy (acute peripheral facial neuropathy), can occur after its administration. A 35-year-old female doctor experienced left-sided facial weakness and paralysis six days after getting the Hepatitis B vaccine. On examination, she had lower motor neuron facial nerve palsy. After excluding other causes, a diagnosis of Bell's palsy was made following Hepatitis B vaccine. She was treated with corticosteroids, antiviral medication, and physiotherapy, which led to a complete resolution over four weeks. Bell's palsy is still an uncommon potential side effect even though the advantages of the Hepatitis B vaccination exceed the risks. Further investigation is necessary to prove a conclusive link between the vaccine and its neurological side effects.

Coexistence Between Antiphospholipid Syndrome and Protein S Deficiency in a Patient With Transverse Sinus Thrombosis: A Rare Association.

The primary antiphospholipid syndrome and protein S deficiency are known hypercoagulable states predisposing to strokes. We present a 34-year-old woman presented to rheumatology clinic complaining of right side weakness and aphasia for 2 months before the visit. There was joint pain in the right elbow and shoulder joints, hyperpigmentation on her face and dry painful red eyes mainly the right eye in addition to dry mouth. She had a history of recurrent abortions. Neurological examination showed hypertonia on right lower and upper limb and normal on left one, while the power was grade 3 on right side and normal in left one. Upper motor neuron signs and facial palsy was noted. Hyperpigmentation in the face was observed. MRI brain showed that left temporoparietal hemorrhagic infraction involving the basal ganglia and MRV brain showed left transverse sinus thrombosis and attenuation of sigmoid and internal jugular vein. B2-glycoprotein Ig AGM, lupus anticoagulant, anticardiolipin (IgG, IgM, and IgA), protein S were positive. ANA profile was borderline for PCNA. We report unusual venous sinus thrombosis with primary antiphospholipid syndrome and acquired protein S deficiency.

Compare the Effectiveness of Mime Therapy on Facial Synkinesis in Idiopathic and Traumatic Lower Motor Neuron Facial Palsy

Background: The seventh cranial nerve has a core function of regulating emotional displays and speech. Facial paralysis, characterized by the loss of voluntary motor control on one or both sides, is commonly attributed to Bell’s palsy which accounts for 50-75% of cases and trauma responsible for 10-23% of cases. Various rehabilitation methods, including Mime Therapy, are employed to enhance facial muscle function. Objective: This study aims to compare Mime Therapy's impact to reduce the synkinesis of a face in individuals with idiopathic and traumatic lower motor neuron facial nerve palsy. Study Design: Experimental, Comparative Study Study Setting: Physiotherapy OPD, Neurology ward, and ENT ward of Himalayan Hospital, Dehradun Participant: This study involved 30 patients, with 20 in Group A (Idiopathic) and 10 in Group B (Traumatic), all of whom had House-Brackmann Scores of 3-5. The patient’s ages ranged from 20 to 70. Outcome Measure: Two outcome measures were used: House Brackmann Score and Sunnybrook Facial Grading System. Result: A noticeable difference in both outcome measures was observed. In the House Brackmann Score for group A (p-value <0.001) and B (p-value=0.016), In Sunnybrook Facial Grading System for group A (p-value<0.001) and B (p-value=0.002). However, when comparing the post-intervention results of both groups, no distinct variation was found in the outcome variables (p-value>0.05). Conclusion: The study provides evidence demonstrating that Mime Therapy has been successful in effectively reducing Facial Synkinesis in patients with both idiopathic and traumatic LMN Facial Palsy. The results indicate a significant improvement in the condition, suggesting that Mime therapy can be an efficacious treatment approach for this type of facial paralysis. KEYWORDS: Mime Therapy, Facial Synkinesis, Idiopathic LMN Facial palsy, Traumatic LMN facial palsy, Bell’s palsy.

Ramsay hunt syndrome: a case report

Ramsay hunt syndrome (RHS) is a neurological condition comprising of complications with varicella zoster virus (VZV) which results in inflammation of geniculate ganglion. In the days to weeks following zoster, various cranial nerve palsies can develop because the varicella-zoster virus is latent in the cranial nerve ganglia. The trigeminal and facial nerves were the most commonly affected by zoster, based on the cranial nerve involvement. Another common impacted nerve was the vestibulocochlear nerve. As VZV is exclusively human pathogen, research on VZV latency is limited to only human ganglia examination. This case report describes about Ramsay Hunt Syndrome induced or also called as Herpes Zoster Oticus caused by Varicella zoster virus. Diagnosis mainly involved laboratory investigations, patient history, treatment data and other relevant information co-related from various literature. A 46-year-old female patient was diagnosed Ramsay hunt syndrome on the basis of clinical findings as right facial palsy, blisters over right pinna, otalgia and right ear erythematous lesions. Patient also exhibited deviation of angle of mouth to left side and unable to close right eye. This was accompanied by elevated erythrocyte sedimentation rate (ESR) exhibiting acute inflammation. Hemoglobin was low and total leukocyte count was high. Following that, corticosteroids and antivirals were prescribed to assist her medical condition. Remission is slow for RHS, hence patient was also advised for rehabilitation therapy to improvise her lower motor neuron facial palsy. Recurrence is possible in long term so it is imperative to initiate early treatment within 72 hours as soon as the symptoms are observed for better patient care.

Recurrent Facial Palsy in an Adolescent - Case Report

Introduction: Recurrent facial nerve paralysis is an unusual occurrence. Main Symptoms: Recurrent facial palsy, oro-facial swelling, and a fissured tongue. Main Diagnosis: Lower Motor Neuron Palsy. No definitive therapy is available, and frequent recurrences are common. Conclusion: Idiopathic recurrent Lower Motor Neuron facial palsy with atypical presentations can be indicative of Melkerson-Rosenthal syndrome.

Facial nerve palsy following bee sting: a case report

One of the most common insect poisoning is bee sting. It can produce local symptoms such as pain, redness, and fever following a local pain. Rarely, anaphylaxis, myocardial infarction, organ failure, epilepsy and other neurological diseases have been reported. Lower motor neuron facial nerve palsy is one of the common diseases of the Otorhinolaryngology clinic. Although it is usually idiopathic, trauma and tumors are the two most common causes. Usually, it is diagnosed clinically and the grade of palsy is based on House Brackmann Classification. We present a case of left Bell’s palsy due to bee sting. A 21-year-old male patient was referred to our clinic for persistent incomplete eye closure for two weeks duration. Upon further history, he complained that prior to the left sided facial weakness he was stung by a bee the night before on his left toe and developed the facial weakness when he woke up in the morning. He did not get immediate treatment. Clinically he had Grade III left lower motor neuron facial nerve palsy. Other ear, nose and throat examinations were unremarkable. He was treated with oral steroid and eye care. One week upon follow up, his facial weakness was completely resolved.

Blood Viscosity and its Clinical Implications in Ischemic Stroke and Chronic Heart Failure: Insights from a Case Report

Background Blood viscosity has received increased attention as a potential predictor of ischemic stroke risk, particularly in patients with chronic heart failure (CHF). Despite the importance of this link, there has been a notable paucity of comprehensive research on the subject. Hence, the major goal of this study was to shed light on the potential importance of blood viscosity in individuals with ischemic stroke and CHF. Case Presentation An 85-year-old male was presented to the emergency department after three days of gradually decreasing consciousness. His medical history included hypertension and CHF. His Glasgow Coma Scale (GCS) was determined to be E2M5V3, and he displayed evidence of upper motor neuron facial palsy as well as right hemiparesis. The clinical assessment scores, which included the NIHSS and mRS, were 10 and 4, respectively. MRI imaging confirmed the existence of several acute infarctions. Other diagnostic procedures, including an x-ray, revealed cardiomegaly and echocardiographic findings were compatible with grade I diastolic dysfunction. His blood viscosity was 8.19 cP, which was much higher than normal. The patient was diagnosed with ischemic stroke, CHF, and hyperviscosity based on these findings. Despite a small increase in blood viscosity to 8.16 cP after a six-day treatment session, the patient showed significant clinical improvement. Unfortunately, he was readmitted immediately after being discharged and died three days later. Conclusion This case demonstrates the importance of blood viscosity in the evaluation and prognosis of patients with ischemic stroke and CHF.

Cerebral Venous Sinus Thrombosis in a Patient with Ulcerative Colitis

Abstract A 25-year-old male with a known history of ulcerative colitis (UC) diagnosed in August 2021 presented with acute onset of a severe bifrontal, throbbing headache, followed by progressive right-sided hemiparesis and upper motor neuron facial palsy, with dysarthria but not visual disturbances. Computed tomography venography confirmed superior sagittal sinus thrombosis. The patient was treated with anticoagulation therapy and medications for UC management, resulting in clinical improvement. This case highlights the importance of recognizing thromboembolic complications in UC patients.

Rare Presentation of Lower Motor Neuron Facial Palsy in Cerebral Venous Thrombosis – A Case Report

Rare Presentation of Lower Motor Neuron Facial Palsy in Cerebral Venous Thrombosis – A Case Report

Lateral Medullary Syndrome Presenting as Section Persistent Singultus and Upper Motor Neuron Facial Palsy in a young Adult: A Rare Case

Lateral Medullary Syndrome (LMS) is a collection of different neurologic symptoms after cerebral haemorrhage/infarction. The areas most frequently afflicted are the cerebellum and the posterolateral portion of the brain stem’s medulla oblongata; the Posterior Inferior Cerebellar Artery (PICA) supplies blood. Dizziness, vertigo, nystagmus, nausea, ataxia, dysphagia, vomiting, hiccups, hoarseness, sensation impaired on half of the face, impaired thermal sensation and pain on the contralateral side of the limbs, trunk, ipsilateral face, along with Horner’s syndrome are amongst the typical symptoms of lateral medullary infarction. Hiccups are among the signs that are simple to ignore, although they can also result in oesophagitis, and respiratory depression, as Wallenberg’s syndrome is the most frequently reported. The authors discuss the case of a 30-year-old male who complained of recurrent, uncontrollable hiccups as an LMS-presenting symptom and was brought to our hospital. He arrived at our emergency room complaining of persistent, intractable hiccups and cerebellar symptoms on the left-side. In addition to being hypertensive, he had a long history of tobacco (chewing) and alcohol addictions dating back six years. He had 7, 9 and 10th cranial nerve involvement. The authors are reporting this case because the patient had Upper Motor Neuron (UMN)-type facial palsy, a rare presentation in LMS

Tuberculosis manifesting as bilateral acute parotid swelling with unilateral lower motor neuron facial palsy: an unusual presentation

A 41-year-old female presented to the otorhinolaryngology department with a history of painful swelling over the bilateral parotid region, low-grade fever for the past one month and progressively worsening left-side facial weakness for the last 15 days. She had received multiple courses of antibiotics elsewhere, which did not result in any improvement except pain. She had no past history of any comorbidities or any previous history of tuberculosis. Examination revealed that she had a non-tender, circumscribed, solitary, 3×3 cm size, firm swelling over the bilateral parotid region. Clinical signs of grade V facial nerve palsy (House and Brackmann classification) were noted. There was a severe grade left lower motor neuron facial nerve palsy (left side) seen. There was no cervical lymphadenopathy. The rest of the head and neck examination was unremarkable. Fine needle aspiration cytology (FNAC) from the most prominent part of the swelling was suggestive of granulomatous inflammation. The patient was initially treated with intravenous antibiotics, supportive care and started on antitubercular drugs (once the diagnosis was established) under the National Tuberculosis Eradication Program (NTEP) to which she responded well and after three months of therapy, her swelling and facial weakness improved significantly. In addition to reporting a completely rare kind of presentation, this paper reviews relevant literature and stresses the need for a high degree of suspicion for tuberculous parotitis in a patient with bilateral parotid swelling. The use of fine needle aspiration is important so that this curable condition can be diagnosed early and medically treated. In this way, surgical intervention can be avoided and further complications can be prevented.

Endoscopic Transpterygoid Corridor for Petroclival Tumors: Case Series and Technical Nuances.

The petroclival area is a technically challenging region to operate owing to the proximity of the internal carotid artery (ICA) and the need to obtain gross total excision of tumors in this area as they are often resistant to radiotherapy. We present our experience with the endonasal endoscopic transpterygoid approach in managing tumors of the petroclival region and discuss various operative nuances for safer resection. A retrospective study of all consecutive cases of lesions occupying the petroclival region that were operated via endonasal endoscopic transpterygoid approach at our center between January 2016 and December 2021 was performed. The study included 14 cases of lesions occupying the petroclival region. Gross total resection by intraoperative observation was achieved in 10 patients, near total decompression was performed in two patients, and the remaining two patients underwent marsupialization of lesion. Postoperatively, one patient had right Lower motor neuron (LMN) facial nerve palsy and one patient required surgery for Cerebrospinal fluid (CSF) rhinorrhea on postoperative day 8. The mean duration of follow-up was 13.8 ± 16.6 months (range: 2-59 months). Four of six patients with visual symptoms on presentation reported improvement in vision, and the other two patients had a stable vision on follow-up. Two patients received radiotherapy postsurgery. No mortality was noted. The extended endonasal endoscopic transpterygoid approach can be safely and efficiently used for petroclival lesions. Very sound knowledge of anatomical relationship, use of intraoperative image guidance to avoid injury to ICA, and multilayer reconstruction with a vascularized nasoseptal flap are required to optimize the clinical outcome.

Investigation of functional connectivity in Bell's palsy using functional magnetic resonance imaging: prospective cross-sectional study.

The most common cause of lower motor neuron facial palsy is Bell's palsy (BP). BP results in partial or complete inability to automatically move the facial muscles on the affected side and, in some cases, to close the eyelids, which can cause permanent eye damage. This study investigated changes in brain function and connectivity abnormalities in patients with BP. This study included 46 patients with unilateral BP and 34 healthy controls (HCs). Resting-state brain functional magnetic resonance imaging (fMRI) images were acquired, and Toronto Facial Grading System (TFGS) scores were obtained for all participants. The fractional amplitude of low-frequency fluctuation (fALFF) was estimated, and the relationship between the TFGS and fALFF was determined using correlation analysis for brain regions with changes in fALFF in those with BP versus HCs. Brain regions associated with TFGS were used as seeds for further functional connectivity (FC) analysis; relationships between FC values of abnormal areas and TFGS scores were also analyzed. Activation of the right precuneus, right angular gyrus, left supramarginal gyrus, and left middle occipital gyrus was significantly decreased in the BP group. fALFF was significantly higher in the right thalamus, vermis, and cerebellum of the BP group compared with that in the HC group (P<0.05). The FC between the left middle occipital gyrus and right angular gyrus, left precuneus, and right middle frontal gyrus increased sharply, but decreased in the left angular gyrus, left posterior cingulate gyrus, left middle frontal gyrus, inferior cerebellum, and left middle temporal gyrus. Furthermore, the fALFF in the left middle occipital gyrus was negatively correlated with TFGS score (R=0.144; P=0.008). The pathogenesis of BP is closely related to functional reorganization of the cerebral cortex. Patients with BP have altered fALFF activity in cortical regions associated with facial motion feedback monitoring.

Prevalence of facial nerve palsy in the neuro-medicine private clinic

Background. Due to dysfunction of the facial nerve (CN VII), Bell’s palsy occurs which is a facial paralysis of unknown cause, but viral infection is suspected. The study aims to determine the prevalence of facial nerve palsy in a private clinic in Basrah. Methods. The study was conducted at a private clinic and involved sixty-five patients with facial nerve palsy. It was a cross-sectional study in which any patient who attended the clinic and exhibited signs and symptoms of lower motor neuron facial nerve palsy underwent an examination to confirm the diagnosis and, if confirmed, were included in the study. While patients with other neurological disorders were excluded. Data collection started between October 1, 2022, and April 30, 2023. A total of 65 patients from the private clinic—males and females—aged from 4 to 70 years old were confirmed as having lower motor neuron facial nerve palsy. Results. This study at a private clinic found that Bell’s palsy was the most common facial paralysis, affecting more males than females and most of the patients in the age range of 18-39 years, also affecting mostly the left side, with onset more frequent during hot and cool weather conditions. Diabetes was significantly related to the onset of Bell’s palsy and weather temperature at the time of the clinic visit. Conclusion. Bell’s palsy has a peak age prevalence in the second and third decades of life, and temperature variations have no effect on the occurrence of Bell’s Palsy. Further studies are needed for an accurate estimation of the number of cases, to assess the severity, impact, and efficacy of Bell’s palsy management.

Management of Bell’s Palsy in an Elderly Patient with Dementia using Kinesiology Tape: A Case Report

Bell’s palsy is an idiopathic nerve lesion involving the facial nerve and is the most common cause of lower motor neuron facial palsy. The management of Bell’s palsy involves the administration of corticosteroids and antiviral medications, physiotherapy including the use of kinesiology tape and time. This case report aims to use kinesiology tape as a rehabilitation tool for Bell’s palsy in an elderly patient with dementia. Due to the patient’s cognitive deficits associated with dementia, she had minimal participation in active rehabilitation and subsequently developed secondary impairments of drooling and ectropion. Kinesiology tape was applied to the patients face to improve facial symmetry, provide support and proprioceptive feedback. Following 10 weeks of application, the patient had reduced ectropion and eye irritation, improved facial symmetry and reduced drooling. The use of kinesiology tape in the rehabilitation of Bell’s palsy may be beneficial in those patients who have reduced capacity to participate in active rehabilitation programs.

From WEMINO To WEBINO With Unilateral LMN Facial Palsy (P5-4.002)

<h3>Objective:</h3> To describe a case of progression from apparent trochlear nerve palsy, to wall-eyed monocular internuclear ophthalmoplegia (WEMINO), to wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) with unilateral lower motor neuron (LMN) facial palsy. <h3>Background:</h3> Various descriptions of INO with cranial nerve palsies are in the literature, but we report a patient with a remarkably instructive stepwise evolution. <h3>Design/Methods:</h3> Review of records of a patient with diplopia at our institution. <h3>Results:</h3> A 42-year-old woman presented acutely with oblique binocular diplopia worsening on right gaze and left head tilt, with left hypertropia. Trochlear nerve palsy was suspected but contrasted MRI brain with orbits, and initial CSF testing were unrevealing. On day 3, the hypertropia partly improved but she developed left eye adduction deficit. Given the fluctuation, myasthenia gravis was considered high in the differential diagnosis while test results were awaited. On day 7, she developed LMN left facial palsy and bilateral adduction deficit with abducting eye nystagmus, leading to the realization that a single progressing lesion in the pontine tegmentum could explain her entire sequence of events. Repeat MRI confirmed a minute enhancing lesion in the floor of the fourth ventricle corresponding to the dorsomedial surface of the left facial colliculus and bilateral medial longitudinal fasciculi (MLF), likely of demyelinating etiology. Her pending CSF tests returned with 7 oligoclonal bands. She received intravenous methylprednisolone and her symptoms nearly resolved by day 14. <h3>Conclusions:</h3> This patient presented with evolving symptoms that appeared to localize to the trochlear nerve initially, but lacked imaging correlate. It is clear in retrospect that her initial presentation represented a skew deviation from early INO, progressing to WEMINO and eventually WEBINO with unilateral fascicular facial palsy. The anatomical correlate was confirmed on repeated imaging. Her clinical course beautifully illustrates the importance of lesion localization for etiological diagnosis. <b>Disclosure:</b> Dr. Senthamarai Siddharthan has nothing to disclose. Dr. Witt has nothing to disclose. Dr. Kini has nothing to disclose. Dr. Vasireddy has nothing to disclose. The institution of Dr. Mathur Kumaraswamy has received research support from Woolsey Pharmaceuticals.

A Perplexing Case of Borrelia Burgdorferi (P9-10.003)

<h3>Objective:</h3> To expose a potential Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) mimicker and understand the significance of diagnostic tests in a case of Bannwarth syndrome. <h3>Background:</h3> Lyme borreliosis is an infectious disease affecting the skin, nervous system, and joints transmitted by the bite of Ixodes Ricinus. Neurological manifestations occur in 3–15% of the cases. Bannwarth syndrome is reported in 3% of the CDC-verified cases of Lyme disease. It presents early within weeks to a few months of initial infection, mainly characterized by painful polyradiculoneuritis. <h3>Design/Methods:</h3> <h3>Case:</h3> A 67-year-old male presented with progressive bilateral upper extremity weakness, sparing the lower extremities with diffuse areflexia, facial diplegia, dysarthria, dysphagia, and diplopia. <h3>Results:</h3> Initial exam was remarkable for bilateral arm weakness with left-sided lower motor neuron facial palsy and dysarthria. Symptoms quickly worsened to facial diplegia and dysphagia with inability to manage secretions. Magnetic resonance imaging (MRI) brain showed hyperintensity with enhancement of the left cerebellum and cauda equina enhancement on MRI lumbar spine. Cerebrospinal fluid (CSF) analysis was remarkable for elevated protein (448 mg/dl), mild pleocytosis (8/mm³), and albumin cytological dissociation. Monoclonal protein IgG kappa was present in the gamma globulin region. History, exam and initial work-up led to a tentative diagnosis of pharyngeal-cervical-brachial variant of AIDP. He was treated with plasmapheresis with mild improvement. Initial Lyme serum and CSF serology were positive with a positive confirmatory CSF western blot. His inpatient electromyography exposed asymmetric, subacute cervical polyradiculopathy with signs of active axonal denervation and reinnervation changes with no acquired demyelination. The patient was started on intravenous Ceftriaxone and physical therapy with significant improvement. <h3>Conclusions:</h3> Lyme disease is a magnificent chameleon; hence it is crucial to keep it among the differential diagnosis. This case emphasizes the importance of EMG amongst diagnostic tools given it ultimately, in combination with Lyme testing, changed the diagnosis and management for the patient. <b>Disclosure:</b> Dr. Sahni has nothing to disclose. Dr. Samaniego has nothing to disclose. Dr. Gates has nothing to disclose.

Incomplete Kawasaki Disease with Peripheral Facial Nerve Palsy and Lung Nodules: A Case Report and Literature Review

The diagnosis of Kawasaki disease (KD) is challenging and often delayed mainly in case of young infants and in presence of an incomplete disease and atypical features. Facial nerve palsy is one of the rare neurologic symptoms of KD, associated with a higher incidence of coronary arteries lesions and may be an indicator of a more severe disease. Here, we describe a case of lower motor neuron facial nerve palsy complicating KD and perform an extensive literature review to better characterize clinical features and treatment of patients with KD-associated facial nerve palsy. The patient was diagnosed at the sixth day of disease and presented extensive coronary artery lesions. A prompt treatment with intravenous immunoglobulins, aspirin and steroids obtained a good clinical and laboratory response, with resolution of facial nerve palsy and improvement of coronary lesions. The incidence of facial nerve palsy is 0.9-1.3%; it is often unilateral, transient, more frequent on the left and seemingly associated with coronary impairment. Our literature review showed coronary artery involvement in the majority of reported cases (27/35, 77%) of KD with facial nerve palsy. Unexplained facial nerve palsy in young children with a prolonged febrile illness should prompt consideration of echocardiography to exclude KD and start the appropriate treatment.

Giant Craniopharyngioma

A 6-year-old girl presented with moderate-intensity headache, frequent vomiting, visual disturbance, and left-sided decreased hearing for 7 months. The neurologic examination revealed a right upper motor neuron facial nerve palsy, left-sided 4-mm sluggish pupil (right: 3-mm reactive), and unsteady gait. Fundoscopy was notable for bilateral papilledema. Brain magnetic resonance imaging with contrast demonstrated a giant multiloculated suprasellar cystic lesion (9.7× 10.5× 7.6 cm). It extended to the left anterior cranial fossa, both middle cranial fossae, and posterior fossa prepontine region with consequent effect on the brainstem and moderate hydrocephalus. The patient underwent a right frontal external ventricular drain insertion and left frontotemporal craniotomy and tumor resection. Histopathologic sections were compatible with adamantinomatous craniopharyngioma. Giant craniopharyngiomas have rarely been reported. This article presents the clinical and radiologic outcomes of a patient with a giant craniopharyngioma.

Eight-and-a-half syndrome as the first presentation of multiple sclerosis in an Asian male: a case report

BackgroundMultiple sclerosis is a diffuse chronic demyelinating disease of the central nervous system. It is relatively uncommon in the Asian population and even more so in males. Despite the usual involvement of the brainstem, eight-and-a-half syndrome remains a rare first presentation in multiple sclerosis. Only a few cases have been reported previously, but none involving the Asian population. Eight-and-a-half syndrome, a neuro-ophthalmological condition, is characterized by one-and-a-half syndrome with ipsilateral lower facial nerve palsy, which localizes lesions to the pontine tegmentum. This case report demonstrates the first case of eight-and-a-half syndrome as the first presentation of multiple sclerosis in an Asian male.Case presentationA healthy 23-year-old Asian man presented with sudden onset of diplopia followed by left-sided facial asymmetry for 3 days. Assessment of extraocular movement revealed left conjugate horizontal gaze palsy. On right gaze, there was limited left eye adduction and horizontal nystagmus of the right eye. These findings were consistent with a left-sided one-and-a-half syndrome. Prism cover test revealed left esotropia of 30 prism diopters. Cranial nerve examination showed left lower motor neuron facial nerve palsy, while other neurological examination was normal. Magnetic resonance imaging brain showed multifocal T2 fluid attenuated inversion recovery hyperintense lesions, involving bilateral periventricular, juxtacortical, and infratentorial regions. A focal gadolinium contrast-enhanced lesion with open ring sign on T1 sequence was seen at the left frontal juxtacortical region. Multiple sclerosis was diagnosed on the basis of the clinical and radiological evidence, which fulfilled the 2017 McDonald criteria. Positive oligoclonal bands in cerebrospinal fluid analysis further confirmed our diagnosis. He had a complete resolution of symptoms 1 month after a course of pulsed corticosteroid therapy, and was subsequently placed on maintenance therapy with interferon beta-1a.ConclusionThis case illustrates eight-and-a-half syndrome as the first presentation of a diffuse central nervous system pathology. A wide range of differential diagnoses needs to be considered in such a presentation as based on the patient’s demographics and risk factors.