Disclosures: John A. Stratton, MD: Nothing to disclose

Case Description: The patient presented to the acute hospital complaining of several hours of blurry vision, double vision, and unsteady gait. Her family had also noted a left sided facial droop. CT of the head was negative; however, MRI of the brain revealed a 5-mm infarct of the left posterior pons. She did not receive tPA due to being outside the therapeutic window. Her stroke workup included an echocardiogram which demonstrated an interatrial shunt, that was found to be a patent foramen ovale. She presented to acute rehab with a left sided lower motor neuron facial nerve palsy, left horizontal gaze palsy, ipsilateral internuclear ophthalmoplegia, and left cranial nerve 3 involvement. She was evaluated by neuro-ophthalmology who confirmed the diagnosis of 8 and ½ syndrome.

Setting: Acute rehabilitation hospital

Patient : A 70-year-old female with history of stroke and resultant left superior quadrantanopia, diabetes mellitus, and hypertension admitted to acute rehab with new pontine stroke.

Assessment/Results: In response to the inability to completely close her left eye, the patient was prescribed erythromycin ointment (twice daily), artificial tears, ocular lubricant, and a left eye patch to be worn nightly. She was also continued on dual anti-platelet therapy for her stroke. She was successfully discharged to home with assistance after her inpatient rehabilitation stay.

Discussion: 8 and ½ syndrome is a rare presentation of pontine stroke but has significant impact on patient’s vision and can have lasting impacts on their stroke rehabilitation if not recognized early and managed properly.

Conclusion: Given appropriate treatment in addition to vision exercises and occupational therapy, patients with this syndrome can show significant improvement.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-rare-pontine-stroke-resulting-in-8-and-1-2-syndrome-a-case-report/