“Sixteen and a half”: a rare neurological syndrome

Received: August 10, 2011
Accepted: January 20, 2012
Ref: Singh R, Chewoolkar V, Chaudhari C. "Sixteen and a half": a rare neurological syndrome. Internet J Med Update. 2012 Jul;7(2):52-54.

"SIXTEEN AND A HALF": A RARE NEUROLOGICAL SYNDROME

Raminder Singh KS*, Vaibhav Chewoolkar** and Chetan Chaudhari***

*Professor and Head, **Assistant Professor, ***Resident, Department of Medicine, Seth G. S. Medical College and KEM hospital, Mumbai, India

(Corresponding Author: Dr. Raminder Singh KS, Department of Medicine, Seth G. S. Medical College and KEM Hospital, Parel, Mumbai-12, India; Tel: 022-24107628, 9820933178; Email: raminder15@rediffmail.com)

ABSTRACT

"Sixteen and a half" syndrome is a recently coined terminology for a novel pontine neuro-ophthalmological condition. It is characterised by "one and a half" syndrome with an additional ipsilateral seventh and eighth cranial nerve palsy (1½+7+8=16½). We hereby present a case with "sixteen and a half" syndrome, characterised by facial asymmetry, conjugate gaze palsy and unilateral deafness with vertigo. As demonstrated by magnetic resonance imaging, the responsible pontine lesion was a brainstem tuberculoma involving the ipsilateral abducens nucleus and the adjacent medial longitudinal fasciculus (MLF), along with facial and vestibulocochlear nerve. The location of the tuberculoma and the clinical presentation is unusual.

KEY WORDS: Syndrome; Ipsilateral; Vertigo; Tuberculoma; Fasciculus

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