[One-and-a-half syndrome: anatomo-clinical considerations apropos of a case].
A 36 years-old man was admitted in September 1987. For 5 years he suffered from 4 recurrent episodes of throbbing headache, tinnitus, nausea, diplopia and divergent strabismus to which a facial palsy was recently added. In all episodes, the symptoms disappeared spontaneously and completely. A neuro-ophthalmological examination at admission disclosed an exotropia of the right eye, gaze paralysis to the left, paralysis of adduction of the left eye and preserved right eye abduction which triggered a rhythmic horizontal nystagmus. The upward and downward gazes and the convergence were well preserved. Moreover, there was a left peripheral facial palsy, and Babinski sign at the right side. Auditory evoked potentials were slowed at the mesencephalopontine transition. CT scan showed a low-density area with no contrast enhancement at the left pontine tegmentum and a left anterolateral atrophy of the pons. CSF examination showed increase in protein content and increase in the IgG content. Additional investigation included a dopplerometry of the cervical arteries, a panangiography and a bidimensional echocardiography which were normal. Diagnosis of one-and-a-half syndrome was made, possibly secondary to multiple sclerosis, and immunossuppressive therapy was initiated.
Andreé
C
C
Servico de Neurologia do Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Brasil.
De Castro
A L
AL
Vincent
M B
MB
De Mattos
J P
JP
Maranhão Filho
P de A
Pde A
Novis
S A
SA
D000328:Adult; D001933:Brain Stem / Q000473:pathology; D005133:Eye Movements; D005403:Fixation, Ocular; D006801:Humans; D008297:Male; D015835:Ocular Motility Disorders / Q000175:diagnosis*; D009886:Ophthalmoplegia / Q000175:diagnosis; D013577:Syndrome; D014057:Tomography, X-Ray Computed
Síndrome 'one-and-a-half': considerações Anatomoclínicas a propósito de um caso.