Macrocephaly in association with pontocerebellar hypoplasia type 1: a paradox.

The present case describes a patient with one and a half syndrome due to pontine granuloma (neurocysticercosis). In one and a half syndrome, the lesion affects the paramedian pontine reticular formation (PPRF) (or the abducens nucleus) and the medial longitudinal fasciculus (MLF) on the same side (the MLF having crossed from the opposite side). It is most often caused by multiple sclerosis, brain stem stroke, brain stem tumors, arteriovenous malformations and infective mass lesions such as tuberculomas.[5] The present case is very unusual because one and a half syndrome was the only abnormality in this patient with pontine neurocysticercosis, because of the unique position of the MLF and PPRF within the brain stem. So, in a highly endemic area like India, neurocysticercosis should be considered as a differential diagnosis of one and a half syndrome. M. P. RANJITH, R. DIVYA, ANUPAM SAHNI Department of Medicine, Netaji Subhash Chandra Bose Medical College, Jabalpur, India