DR. DIPIKA SAINATH

Abstract

“One-and-a-half” syndrome is a concomitance of horizontal gaze palsy and ipsilateral Internuclear Ophthalmoplegia (INO). It is a dysconjugate gaze palsy with impaired adduction ipsilaterally and nystagmus on abduction contralaterally. 60-year-old hypertensive patient presented with right hemiparesis and binocular diplopia. Clinical examination unveiled limited adduction in left eye, nystagmus on abduction in right eye, left gaze palsy, right sided facial weakness, right exotropia, up-gaze palsy and defective convergence. Crossed hemiparesis and facial palsy may confound the diagnosis. Contralateral paralytic pontine exotropia (PPE) and up-gaze palsy are unusual features. A conglomerate of above manifestations may pose a diagnostic ambiguity in one-and-a-half syndrome. This report describes one-and-a-half syndrome with contralateral upper motor neuron facial palsy complementing the ‘crossed’ hemiparesis.