One and a half syndrome
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Causes
Causes of the one and a half syndrome include pontine haemorrhage, ischemia, tumors, infective mass lesions such as tuberculomas, demyelinating conditions like multiple sclerosis, Arteriovenous malformation, Basilar artery aneurysms and Trauma.
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Anatomy
The syndrome usually results from single unilateral lesion of the paramedian pontine reticular formation and the ipsilateral medial longitudinal fasciculus. An alternative anatomical cause is a lesion of the abducens nucleus (VI) on one side (resulting in a failure of abduction of the ipsilateral eye and adduction of the contralateral eye = conjugate gaze palsy towards affected side), with interruption of the ipsilateral medial longitudinal fasciculus after it has crossed the midline from its site of origin in the contralateral abducens (VI) nucleus (resulting in a failure of adduction of the ipsilateral eye).
Treatment
There have been cases of improvement in extra-ocular movement with botulinum toxin injection. Cases related to multiple sclerosis sometimes subside with adequate treatment.