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From Eight-and-a-Half to Nine: A Case Report Highlighting an Uncommon Brainstem Syndrome.
Jamir Pitton Rissardo1, Vishnu Vardhan Byroju1, Arthur Gribachov1
1Department of Neurology, Cooper University Hospital.
The Neurologist
|May 14, 2026
Summary
Nine syndrome, a rare brainstem condition, is primarily caused by pontine lesions, often from ischemic stroke. Early MRI and vascular imaging are crucial for diagnosis and management of this neurological disorder.
Area of Science:
- Neurology
- Neuroscience
- Clinical Medicine
Background:
- Nine syndrome is a rare brainstem disorder characterized by one-and-a-half syndrome, ipsilateral facial weakness, and contralateral long-tract signs.
- It typically arises from lesions in the pontine tegmentum, frequently due to acute ischemic stroke.
Purpose of the Study:
- To systematically review published cases of Nine syndrome.
- To summarize demographics, clinical features, imaging findings, etiology, and outcomes.
Main Methods:
- Systematic literature review of PubMed, Scopus, and Web of Science databases.
- Descriptive analysis of data from 25 identified cases.
Main Results:
- Ischemic stroke was the predominant etiology (68%), followed by hemorrhagic stroke (20%) and demyelinating conditions (12%).
- Common clinical features included contralateral hemiparesis (52%), hemiataxia (24%), and sensory deficits (32%).
- Complete recovery was infrequent (4%), with most patients experiencing partial improvement.
Conclusions:
- Nine syndrome results from strategically located pontine lesions affecting adjacent structures.
- The prevalence of ischemic stroke underscores the importance of early MRI and vascular imaging.
- Recognizing this rare syndrome facilitates accurate diagnosis and targeted therapeutic strategies.
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