Dr.Geoffrey Joju, Dr. Anthrayos C V Kakkanatt, Dr.David Pudukadan, Ms. Minu Sasikumar
A 65 year old male who had an episode of Left sided hemiplegia was brought to the OPD with complaints of restriction of eye movements and diplopia which started in association with stroke 1 week back. The diplopia was more on looking to the sides.
He also had difficulty in closing Right eye and deviation of mouth to left side.Since 2 days he started having watering and redness of Right eye.On examination his vision was 6/12 both eyes.Right sided facial nerve palsy was noted.Restriction of all eye movements except superior , inferior gaze and Left eye abduction.Exposure keratitis of RE present.MRI brain showed Acute lacunar infarcts in Right caudate nucleus body and in dorsal tegmentum of pons in between Medial Longitudinal Fasciculi.
The patient was started with anticoagulants and neuroprotectives.He was given antibiotic eye ointment and artificial tears for exposure keratitis and suggested tarsorrhaphy later.Eight and a half syndrome is One and a half syndrome plus 7th nerve palsy.