One and one-half syndrome with supranuclear facial weakness: magnetic resonance imaging localization.

OBJECTIVE

To provide clinicoanatomical correlation for a small pontine tegmental ischemic stroke producing the one and one-half syndrome associated with supranuclear facial weakness.

DESIGN

Case report.

SETTING

Tertiary care center.

PATIENT

A 70-year-old man developed left-sided facial weakness sparing the forehead, a left internuclear ophthalmoplegia, and a complete left horizontal gaze palsy immediately after percutaneous transluminal coronary angioplasty. Magnetic resonance imaging demonstrated a small lesion in the left paramedian aspect of the dorsal pontine tegmentum.

MAIN OUTCOME AND RESULTS

Electromyographic findings were consistent with supranuclear facial involvement. The patient had nearly complete recovery after 1 year.

CONCLUSIONS

To our knowledge, this is the first report of supranuclear facial weakness in association with the one and one-half syndrome. The location of the lesion provides evidence of the existence of corticofugal fibers that extend to the facial nucleus in the dorsal paramedian pontine tegmentum.