George Zakhia1, Han Wang2
1Mayo Clinic Health System, Mankato, 2Mayo Clinic Health System Mankato
Objective:
Half-and-half syndrome is a rare oculomotor condition when there is impairment of half of the contralateral gaze (due to unilateral internuclear ophthalmoplegia) as well as impairment of half of the ipsilateral gaze (due to injury to the abducens nerve fascicules without damage to the abducens nucleus). There were only three case reports found, two from demyelinating disorders and one from hemorrhage.
Background:
The patient is a 61 year-old male with history of hepatitis C who presented with sudden-onset dizziness, left hand numbness, diplopia, and unsteadiness with gait.
Design/Methods:
His neural exam was significant for right eye abduction and adduction palsy, reduced sensation to light touch in the fingers of the left hand and dysmetria of left arm and leg. MRI brain revealed a right posterior parasagittal pontine infarction.
Results:
He presented outside of intravenous thrombolysis window. He was treated with antiplatelet. He was found to have elevated LDL and was started on statin. At two months follow-up, his symptoms have completely resolved.
Conclusions:
We believe this is the first reported case of half-and-half syndrome due to acute ischemic stroke and fourth reported case of any etiology. It is an extreme rare condition and likely underreported. When identified, it localizes well to dorsal pontine.