Eight and a Half Syndrome from Multiple Sclerosis

A 50 year old woman with a past medical history of hypertension presented with sudden onset of one-and-a-half syndrome on top of a sub-acute 7th nerve palsy. Her MRI findings showed several contrast enhancing lesions including a pontine lesion. The lumbar puncture (LP) showed oligoclonal bands. Multiple sclerosis (MS) was diagnosed, with the rare initial presentation of eight-and-a-half syndrome. The patient was treated with intravenous steroids, then placed on a disease modifying agent. In this article, we discuss the patient’s imaging and review the pathology of eight-and-a-half syndrome.