Twenty-and-a-half syndrome: a case report

Area of Science:

• Neuro-ophthalmology
• Neurology
• Stroke Medicine

Background:

• The classification of neuro-ophthalmological syndromes includes named numerical entities.
• This report introduces a novel syndrome, termed "twenty-and-a-half syndrome".

Observation:

• A 45-year-old woman presented with acute vomiting and imbalance.
• Clinical examination revealed left-sided ataxic hemiparesis, one-and-a-half syndrome, and bilateral seventh and right fifth nerve palsy.
• Brain MRI identified an acute infarct in the right pons and medulla.

Findings:

• The patient's presentation was diagnosed as the newly described twenty-and-a-half syndrome.
• The underlying cause was determined to be a lacunar infarct in the posterior circulation affecting the pons and medulla.
• The syndrome is characterized by the combination of one-and-a-half syndrome with bilateral seventh and right fifth nerve palsy.

Implications:

• This case expands the spectrum of clinical manifestations of posterior circulation stroke.
• Recognition of twenty-and-a-half syndrome is crucial for accurate diagnosis and management of specific stroke presentations.
• Further research into the etiology and prevalence of this syndrome is warranted.