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Letter
Botulinum toxin treatment of “one and a half syndrome”
  1. A Kipioti,
  2. R H Taylor
  1. York District Hospital, Wigginton Road, York YO3 7HE, UK
  1. Correspondence to: Miss Tina Kipioti, Eye Department, Clarendon Wing, Leeds General Infirmary, Leeds LS2 9NS, UK; tinakipioti{at}doctors.org.uk

https://doi.org/10.1136/bjo.87.7.918-a

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    Complex forms of nystagmus and conjugate eye movement deficits are generated if the pontine paramedian structures are damaged. These can cause troublesome and occasionally disabling symptoms. The combination of one sided horizontal gaze palsy and ipsilateral internuclear ophthalmoplegia (INO), known as “one and a half syndrome,” is most commonly caused by demyelination, vascular disease or tumours.1,2 Ophthalmological symptoms include diplopia, oscillopsia or blurred vision and are often remarkably challenging to manage.3 Since the introduction of botulinum toxin A (BTA)4 for ocular motility disorders and nystagmus5 there have been a number of reports that establish the use of BTA as a treatment option in the management of complex ocular motility disorders.

    We report the use of BTA in a patient with one and a half syndrome.

    Case report

    A 52 year old white male patient was admitted to our institution with dysarthria and right arm weakness of sudden onset. Three years before he had suffered a post-coital subarachnoid haemorrhage from a right middle cerebral artery aneurysm. He had had his aneurysm clipped and had managed an almost complete recovery. He was overweight and hypertensive.

    When he was admitted it was noted that he had right …

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