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One and one-half syndrome with supranuclear facial weakness: magnetic resonance imaging localization
C A Anderson1, E Sandberg, C M Filley
1Department of Neurology, University of Colorado School of Medicine, and the Denver Veterans Affairs Medical Center, 80262, USA.
Objective:
To provide clinicoanatomical correlation for a small pontine tegmental ischemic stroke producing the one and one-half syndrome associated with supranuclear facial weakness.
Design:
Case report.
Setting:
Tertiary care center.
Patient:
A 70-year-old man developed left-sided facial weakness sparing the forehead, a left internuclear ophthalmoplegia, and a complete left horizontal gaze palsy immediately after percutaneous transluminal coronary angioplasty. Magnetic resonance imaging demonstrated a small lesion in the left paramedian aspect of the dorsal pontine tegmentum.
Main Outcome And Results:
Electromyographic findings were consistent with supranuclear facial involvement. The patient had nearly complete recovery after 1 year.
Conclusions:
To our knowledge, this is the first report of supranuclear facial weakness in association with the one and one-half syndrome. The location of the lesion provides evidence of the existence of corticofugal fibers that extend to the facial nucleus in the dorsal paramedian pontine tegmentum.