Nine Syndrome: Unravelling A Rare Mystery of Neurology
Keywords:
Brainstem Stroke, Pontine Infarction, Neurology, Case ReportAbstract
Nine syndrome is a rare neurological condition characterized by ipsilateral conjugate horizontal gaze palsy (the "one"), ipsilateral internuclear ophthalmoplegia (INO) (the "half"), and ipsilateral lower motor neuron (LMN) facial cranial nerve palsy (the ‘’seven’’), which comprises ‘’Eight-and-a-half’’ in total. Here, the only possible horizontal movement is contralateral abduction. If ‘’Eight-and-a-half’’ is associated with contralateral hemiplegia, it is called ‘’Nine Syndrome’’. Common etiologies of this condition include vascular, demyelinating, and ICSOL. Here, we report the case of a 48-year-old diabetic man with no prior hospitalization who presented to the medicine department with the sudden onset of diplopia, vertigo, and facial asymmetry for 9 hours. On detailed neurological examination, he was found to have left-sided lower motor neuron facial palsy, impaired horizontal ocular movement involving the left eye, horizontal nystagmus on the abducting right eye, and right-sided extensor plantar response. The clinical constellation was consistent with Nine syndrome. An MRI performed later established an ischemic lesion in the left pons. Thrombolysis was not performed because the patient presented outside the recommended therapeutic time window. The patient showed early neurological improvement and was discharged with advice to have follow-up.
J MEDICINE 2026; 27(2): 141-144
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