Article Text

PDF

036
THE 17 SYNDROME
  1. Matthew RB Evans,
  2. Robert Weeks
  1. King's College Hospital

Abstract

A 58-year-old man woke from uneventful right cerebellopontine angle surgery (grade I schwannoma resection) with severe, lower motor neurone (LMN) facial diplegia and near-complete nuclear horizontal ophthalmoplegia, uncorrectable by vestibulo-ocular reflex. Vertical gaze and convergence were normal. Examination was otherwise normal, excepting right sensorineural anacusis (a short HD video will be shown). CT brain revealed expected post-operative changes. MRI wasn't possible due to a pacemaker, inserted for symptomatic bradyarrhythmias. There has been no improvement after 12 months.

We attribute this presentation to infarction of a small neuroanatomically dense section of the paramedian dorsocaudal pontine tegmentum, due to occlusion of a single paramedian tegmental pontine perforating artery – an anatomic variant, the terminal bifurcation of which supplies both sides of midline. Ophthalmoplegia, due to bilateral ‘1½ syndrome’, results from involvement of both abducens nuclei and medial longitudinal fasciculi; and facial diplegia from involvement of the genu of the intra-axial fasciculus of both facial nerves.

The combination of ‘1½ syndrome’ and ipsilateral LMN facial palsy: ‘the 8½ syndrome’, is a well described brainstem stroke syndrome. A single case of 1½ syndrome with LMN facial diplegia, termed ‘the 15½ syndrome’ has been reported. To our knowledge, this is the first reported case of acute LMN facial diplegia and horizontal ophthalmoplegia: ‘the 17 Syndrome’ (7+7+1½+1½).

  • EPILEPSY

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.