The One-and-A-Half Syndrome and Associated Neurological Symptoms Related to Pontine Hemorrhage-A Case Report

因橋腦出血所造成1又1/2症候群及相關的神經學症狀－病例報告

吳鴻哲(Horng-Jer Wu) ； 趙世鈞(Shih-Chun Chao) ； 林浤裕(Hung-Yu Lin)

《中華民國眼科醫學會雜誌》 46卷3期 (2007/09) Pp. 240-245

https://doi.org/10.30048/ACTASOS.200709.0007

摘要

目的：報告一個因橋腦出血而造成罕見的1又1/2症候群及相關神經學症狀的病例。
方法：病例報告。
結果：1個54歲女性病患因突然發作的頭痛暈眩意識改變而入院，神經外科在她的情況穩定後因病人抱怨視力模糊及右眼皮下垂而會診眼科，經檢查發現兩眼共軛的水平注視麻痺，唯一眼球的水平運動是左眼的外展（1又1/2症候群），在眼球的垂直運動及會聚方面是正常的，於神經學方面的檢查則顯示右半臉部無力，鼻唇皺摺平坦，右前顏皺紋的消失及右眼皮下垂加上左半側輕癱，電腦斷層影像學檢查顯示右邊橋腦部位有出血及延伸到腦室的現象。
結論：造成1又1/2症候群的原因包括橋腦出血腫塊及去髓鞘疾病如多發性硬化症，1又1/2症候群不會是單一眼球方面的症狀，通常伴隨著其他腦神經的麻痺，單側輕癱或感覺減退，病程取決到損傷部位的程度及範圍。

並列摘要

Purpose: To report a case of One and a halt syndrome related to sudden hemorrhage of the pontine area.
Methods: A Case Report
Results: A 54-year-old female patient was admitted to our hospital due to a sudden onset of conscious disturbance, headache, and dizziness, and shortness of breath. The Neurosurgery Department consulted us for her complaints of blurring vision, and ptosis of the right eyelid after her condition was stable. Complete ocular exam demonstrated that conjugate horizontal gaze palsy to the right direction, impaired adduction of the right eye and the only remaining horizontal eye movement was the abduction of the left eye (one and a half syndrome). Vertical ocular movement was normal. Neurology exam also showed signs of the right facial weakness, flattening of nasolabial fold and absence of the right forehead wrinkling. CT scan revealed that hemorrhage over the ponhine area with intraventricular extension.
Conclusion: Causes of One and a halt syndrome include pontirie area hemorrhage, ischemia, tumor, infected mass lesion such as tuberculoma and demyelinating condition like multiple sclerosis. One and a halt syndrome is not an isolated syndrome but usually companied with cranial nerve palsies, hemiplegia, or hemi-hypoesthesia. The outcome maybe depends on the level of lesion involved.

並列關鍵字

one and a half syndrome ； paramedian pontine reticular formation ； medial longitudinal fasciculus ； pontine hemorrhage