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Background An eight-and-a-half syndrome is the combination of a one-and-a-half syndrome with an ipsilateral LMN facial palsy (1). It is caused by damage to the dorsal pontine tegmentum at the level of the facial colliculus and presents with facial weakness and diplopia(2).Clinical Case We present a case of a 84 year old Hospital volunteer who presented with diplopia followed by a right sided facial droop with involvement of the eyebrow. Examination showed a complete right sided horizontal gaze palsy with the only remaining horizontal movement being abduction of the left eye with nystagmus. Vertical eye movements and accommodation were preserved and there was a LMN right sided facial palsy. MRI was initially reported as normal but subsequent focused review showed a tiny foci of acute ischaemia in the right dorsal pons. She was treated for acute stroke and recovered rapidly with no lasting deficit.Conclusion An eight-and-a-half syndrome is a rare syndrome combining a facial palsy with an INO, and localises specifically to the ipsilateral dorsal pons. MRI imaging made without awareness of the full clinical syndrome or by non-specialist radiologist may miss small lesions and focused review of imaging may be needed to correctly identify a cause.jacob.john.roelofs@gmail.com