International Clinical and Medical Case Reports Journal (ISSN: 2832-5788) | Volume 2, Issue 12 | Case Report | Open Access

Eight-and-Half Syndrome- A Quick Surprising Change in the Manifestation

Sheetal V Girimallanavar*

Associate Professor, Department of Ophthalmology, Vydehi Institute of Medical Sciences & RC, Bengaluru, India

*Correspondence to: Sheetal V Girimallanavar 

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Introduction: The "one-and-a-half syndrome" is an eye movement disorder characterized by a unilateral gaze palsy and an ipsilateral internuclear ophthalmoplegia. When it is associated with seventh nerve palsy(Bell’s palsy) on the same side it is called Eight and half syndrome.

Case Report: A 72year old female patient presented to the medicine OPD with complaints of slurring of speech since 3 days along with deviation of angle of mouth and involuntary movements of left upper and lower limb. Ophthalmology reference was given in view restricted extraocular movements On ocular examination (bedside) Visual Acuity in both eyes was counting fingers >3mts. Extraocular movements showed restriction of movements. Anterior segment examination showed lagophthalmos of the left upper eyelid, pupils bilateral sluggishly reactive to light ,both eyes pseudophakia, right end gaze nystagmus. Fundus examination showed normal disc both eyes with Cup Disc Ratio(CDR) 0.4,with both eyes macular scar, dot-blot haemorrhages along with hard exudates were present in all quadrants, vessels showed arteriolar attenuation with A-V crossing changes. CT brain done showed space occupying lesion (3x3cm) in the left cerebellar hemisphere with surrounding edema compressing the 3rd & 4th ventricles with tonsillar herniation. Patient was started on Inj. Mannitol 100ml and Inj.Dexamethasone 4mg following which there was improvement in the ocular findings on day 2.

Conclusion: The purpose of our presentation of this case is to highlight the alteration in the ophthalmic-neurological manifestation of presentation in a case pertaining to central nervous system with start of medication.


One-and-a-half syndrome; Gaze palsy; Internuclear ophthalmoplegia


Sheetal V Girimallanavar, Tanvi R Rai, Vittal I Nayak. Eight-and-Half Syndrome- A Quick Surprising Change in the Manifestation. Int Clinc Med Case Rep Jour. 2023;2(12):1-5.