Metastatic renal cell carcinoma presenting as one-and-a-half
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”One-and-a-half syndrome” manifests as conjugate horizontal gaze palsy to one side, along with internuclear ophthalmoplegia.This article reports a case of 43-year-old male, presented with sudden onset binocular diplopia on lateral gazes. Ocular examination showed features of ipsilateral one-and-a-half syndrome. Comprehensive systemic work in conjunction with magnetic resonance imaging of the brain illustrated irregular mixed solid and cystic lesions in the brainstem, possibly indicative of brain metastases. Further imaging revealed hidden renal cell carcinoma as a primary neoplasm, which led to secondary manifestations.

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