A rare diagnosis of nine syndrome: Clinical, imaging findings, and literature review

Abstract

In this article, we reported a rare case of nine syndrome, which is characterized by clinical signs of the one-and-a-half syndrome, ipsilateral facial palsy, contralateral hemiparesis, hemihypesthesia, or ataxia. A 44-year-old male presented with sudden onset of double vision for 3 days. Examination revealed left horizontal gaze palsy, internuclear ophthalmoplegia, left lower motor neuron facial nerve palsy with right hemiplegia, and hemihypesthesia. Magnetic resonance imaging brain showed evidence of acute infarction at the left paramedian pons. Magnetic resonance angiography revealed a beaded small-caliber basilar artery suggestive of intracranial vasculopathy in the posterior circulation. The patient has been treated with an antiplatelet and lipid-lowering agent. His right hemiparesis has improved, but the ocular motility and left facial paresis persisted. The literature reviews of 14 cases of nine syndrome were discussed, and the biography background, clinical pictures, etiology, neuroimaging, treatment, and recovery status were described.

Keywords

• eight-and-a-half syndrome
• horizontal gaze palsy
• paramedian pontine
• pseudoptosis