What Time Is It? It Is 8 and 1/2 Time: A Rare Case of Ischemic Stroke Consistent With Eight-and-a-Half Syndrome

Eight-and-a-half syndrome is a rare neuro-ophthalmic syndrome characterized by conjugate horizontal gaze palsy, ipsilateral internuclear ophthalmoplegia, and ipsilateral facial nerve palsy. It results from a lesion affecting the paramedian pontine reticular formation, the medial longitudinal fasciculus, and the abducens nucleus of the same side, at the level of the lower pons. We present a case of a 49-year-old man with 2-week diplopia and 3-day right-sided facial droop, drooling, and dysarthria. CT angiography of the head and neck revealed atherosclerotic disease, with decreased caliber of the basilar artery at the level of the pons. Brain MRI showed a subacute ischemic lesion in the right dorsal pons. The prognosis is favorable with improvement of facial palsy and ocular symptoms. In addition to treating the underlying etiology, neurorehabilitation is indicated. This case highlights the importance of identifying the level of the lesion in patients with gaze palsy and facial droop, as well as correlating the findings into syndromic diagnoses.