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An internuclear ophthalmoplegia with ipsilateral abduction deficit: Half and half syndrome
Journal article   Open access   Peer reviewed

An internuclear ophthalmoplegia with ipsilateral abduction deficit: Half and half syndrome

S Randhawa, V. A Shah, R. H Kardon and A. G Lee
Journal of Neurology, Neurosurgery and Psychiatry, Vol.78(3), pp.309-bcr2006099135
2007
DOI: 10.1136/bcr.2006.099135
PMCID: PMC2117658
PMID: 17308292
url
https://doi.org/10.1136/bcr.2006.099135View
Published (Version of record) Open Access

Abstract

A 16-year-old white boy was assaulted with fists and boots. In the emergency room, he was ataxic and had occipital scalp lacerations. Examination of both eyes showed that visual acuity was 20/20, with a normal pupils. Ocular motility showed mild left hypertropia and a moderate to severe exotropia in all cardinal positions of gaze (greatest in right gaze; fig 1). The near reaction and convergence effort could overcome the adduction deficit in the left eye consistent with a pontine internuclear ophthalmoplegia. On right gaze, he had a severe underaction of adduction in the left eye associated with an abducting dissociated horizontal nystagmus in the right eye. He also had a moderate underaction of abduction in the left eye (fig 1). On upgaze, both eyes were found to have developed vertical gaze-evoked nystagmus. The ocular motility examination suggested a left internuclear ophthalmoplegia with a partial left sixth nerve palsy.1 The fundus examination was normal. However, conjugate torsion was observed towards the hypotropic right eye, consistent with a skew deviation as the cause of the left hypertropia.2 Magnetic resonance imaging showed a focal haemorrhagic lesion in the floor of the aqueduct in the region of the dorsal pons (fig 3).

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