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Inicio Archivos de la Sociedad Española de Oftalmología (English Edition) Fisher one-and-a-half syndrome due to a bulb protuberance cavernoma
Journal Information
Vol. 94. Issue 6.
Pages 309-312 (June 2019)
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Vol. 94. Issue 6.
Pages 309-312 (June 2019)
Short communication
Fisher one-and-a-half syndrome due to a bulb protuberance cavernoma
Síndrome del uno y medio de Fisher a causa de un cavernoma bulbo-protuberancial
J.A. Andermatten
Corresponding author

Corresponding author.
, A. Elua Pinin, N. Samprón Lebed, A. Bollar Zabala, M. Arrazola Schlamilch, E. Urculo Bareño
Servicio de Neurocirugía, Hospital Universitario Donostia, Donostia-San Sebastián, Gipuzkoa, Spain
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The one and a half Fisher syndrome is produced by a unilateral lesion in the dorsal and inferior part of the pons located specifically in the pontine tegmentum. This is an area that contains the medial longitudinal fasciculus (LMF), the paramedian pontine reticular formation (PPRF) and the nucleus of the sixth cranial nerve, responsible for the horizontal movements of the gaze. Clinically it manifests with conjugate gaze palsy with internuclear ophthalmoplegia.

The case is reported on a 60 year-old patient, who presented with binocular diplopia, ophthalmoplegia and paralysis of the gaze conjugated to the left. Imaging studies were performed that showed a hemi-protuberant hematoma secondary to a cavernoma. As expected, he presented with several episodes of re-bleeding with clinical worsening: headache, diplopia, tetraparesis, and hypoaesthesia in the right side of the face, as such that the microsurgical exeresis of the protuberant cavernoma was considered.

One and a half syndrome
Fisher syndrome
Brain cavernoma
Internuclear ophthalmoplegia
Pontine hemorrhage

El síndrome del uno y medio de Fisher está producido por una lesión unilateral en la parte dorsal e inferior de la protuberancia localizada específicamente en el tegmento pontino, área que contiene el fascículo longitudinal medial (FLM), la formación reticular paramediana pontina (FRPP) y el núcleo del VI par craneal, responsables de los movimientos horizontales de la mirada. Clínicamente se manifiesta con una parálisis conjugada de la mirada con oftalmoplejía internuclear ipsilateral.

Se presenta el caso de una paciente de 60 años de edad que, tras presentar diplopía binocular, oftalmoplejía y parálisis de la mirada conjugada a la izquierda se realizaron estudios de imagen observándose un hematoma hemiprotuberancial secundario a un cavernoma. Tras conducta expectante presentó varios episodios de resangrados con empeoramiento clínico: cefalea, diplopía, tetraparesia e hipoestesia en hemicara derecha, por lo que ante tal evolución se planteó exéresis microquirúrgica del cavernoma protuberancial.

Palabras clave:
Síndrome del uno y medio
Síndrome de Fisher
Cavernoma encefálico
Oftalmoplejía internuclear
Hemorragia pontina


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