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POSSIBLE NINE SYNDROME A RARE PRESENTATION OF NEURO OPHTHALMIC PONTINE SYNDROME ABSTRACT Eight and a half is characterized by horizontal gaze palsy in one eye associated with internuclear ophthalmoplegia INO and ipsilateral lower motor neuron LMN type VII nerve palsy When this is associated with contralateral hemiparesis and or hemihypesthesia it is called possible NINE syndrome We report a case of 56 year old male presented with clinical signs suggestive of right side eight and a half syndrome with contralateral hemiparesis confirmed by MRI Brain having acute infarction in the same intended territory This demonstrates the importance of identifying neuro ophthalmic signs in stroke patients and correlating those appropriately will lead to precise localization of the lesion anatomically at bedside Key words internuclear ophthalmoplegia one and a half syndrome horizontal gaze palsy eight and a half syndrome nine syndrome INTRODUCTION Miller fisher first describe a variant of brainstem stroke which had the combinations of horizontal gaze palsy in one eye with ipsilateral internuclear ophthalmoplegia and named as one and a half syndrome OHS 1
