Open AccessSixteen-and-a-half syndrome with metastatic pons tumor
Author(s) -
Shin-Myeong Choi,
Tae Gi Kim,
Junkyu Chung,
Jin-Ho Joo,
In-Ki Park,
Sang Woong Moon,
Jae-Ho Shin
Publication year - 2019
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000018006
Subject(s) - medicine , diplopia , internuclear ophthalmoplegia , pons , palsy , metastasis , brain metastasis , surgery , radiology , cancer , pathology , alternative medicine , psychiatry , multiple sclerosis
Rationale: One-and-a-half syndrome (OAAH) is characterized as the combination of ipsilateral horizontal gaze palsy and internuclear ophthalmoplegia. OAAH syndrome accompanied with 7th and 8th cranial nerve palsy is called 16-and-a-half syndrome. We aimed to report the case of 16-and-a-half syndrome with metastatic pons tumor. Patient concerns: A 57-year-old male diagnosed with nonsmall-cell lung cancer (NSCLC) with brain metastasis occurring 15 months ago was referred to our clinic with the chief complaint of horizontal diplopia and right gaze palsy. Diagnosis: According to the patient symptom, ocular examination, and radiographic findings, he was diagnosed as 16-and-a-half syndrome which was caused by brain tumor metastasis from NSCLC. Interventions: We referred him to hemato-oncology department and he was treated with radiation and supportive therapy. Outcomes: Unfortunately, the patient passed away 1 month later without improvement of ophthalmoplegia. Lessons: The clinical findings of our case indicate 16-and-a-half syndrome caused by brain tumor metastasis from NSCLC, which to our knowledge has not been previously reported. The case highlights a rare cause of OAAH spectrum disease and the importance of a systemic work-up including associated neurologic symptoms and brain imaging in patients with horizontal gaze palsy.