One and a Half Syndrome Following Resection of a Posterior Fossa Epidermoid Cyst

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Title One and a Half Syndrome Following Resection of a Posterior Fossa Epidermoid Cyst
Creator Christine Xu; Claire Basco, MS, NP-C; Kiarash Shahlaie; Yin Allison Liu
Affiliation (CX) Ophthalmology, University of California, Davis; (CB) Neurosurgery, University of California, Davis; (KS) Neurosurgery, University of California, Davis; (YAL) Departments of Ophthalmology, Neurology, and Neurological Surgery, University of California, Davis
Subject Abducens Nucleus; Epidermoid Cyst; Extraocular Movements; Gaze Palsy; Internuclear Ophthalmoplegia; Medial Longitudinal Fasciculus; Neurosurgery; One and a Half Syndrome
Description This is a case of One and a Half Syndrome following resection of a posterior fossa epidermoid cyst. A 31-year-old male initially presented with left facial droop and bilateral ptosis, and a "down and out" gaze of the left eye. He underwent imaging and was diagnosed with an epidermoid cyst located in the posterior cranial fossa. Suboccipital craniotomy was performed with resection of the cyst and expansile duraplasty. Post-op month 2 after the resection, he presented to neuro-ophthalmology clinic with binocular horizontal double vision. On exam, there was resolution of the prior ptosis, left down and out gaze, and left facial droop. On testing of extraocular movements, nystagmus was present in up and down gaze. The patient was unable to look to the right. When attempting to look left, there was left nystagmus and a deficit of right adduction. With the left eye being covered, there was some improvement in right adduction. The findings were consistent with One and a Half Syndrome, suggesting involvement of the right 6th nerve nucleus which was responsible for right gaze palsy, and involvement of the right medial longitudinal fasciculus leading to left intranuclear ophthalmoplegia. Although intracranial masses can cause One and a Half Syndrome such as in this case, other causes include vascular or demyelinating disease.
Date 2023-11
Language eng
Format video/mp4
Type Image/MovingImage
Collection Neuro-Ophthalmology Virtual Education Library: Yin Allison Liu Collection: https://novel.utah.edu/collection/yin-allison-liu/
Publisher North American Neuro-Ophthalmology Society
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah
Rights Management Copyright 2023. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright
ARK ark:/87278/s60dsxj8
Setname ehsl_novel_yal
ID 2379425
Reference URL https://collections.lib.utah.edu/ark:/87278/s60dsxj8
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