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Magnetic Resonance Imaging Localization

C. Alan Anderson, MD; Elliot Sandberg, MD; Christopher M. Filley, MD; Sally L. Harris, MD; Kenneth L. Tyler, MD

Arch Neurol. 1999;56:1509-1511.

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.

From the Departments of Neurology (Drs Anderson, Sandberg, Filley, Harris, and Tyler), Surgery (Division of Emergency Medicine) (Dr Anderson), Radiology (Dr Sandberg), Psychiatry (Dr Filley), Medicine (Dr Tyler), Microbiology (Dr Tyler), and Immunology (Dr Tyler), University of Colorado School of Medicine, and the Denver Veterans Affairs Medical Center (Drs Anderson, Sandberg, Filley, and Tyler), Denver, Colo.

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