Wall-Eyed Bilateral Internuclear Ophthalmoplegia (WEBINO) in a Patient With a Unilateral Midbrain Infarction

Abstract

Introduction: Wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) is a rare variation of internuclear ophthalmoplegia associated with bilateral lesions of the medial longitudinal fasciculus. Case Report: In this case, the edematous lesions of the ipsilateral midbrain infarction appeared to compress the contralateral medial longitudinal fasciculus, resulting in WEBINO. Treatment of focal cerebral edema caused by ischemic stroke is still under debate. However, in this case, antiedema treatment was implemented to prevent the sequelae of the edematous lesion caused by a midbrain infarction, and a relatively rapid improvement of ocular symptoms was observed. Conclusion: Herein, we report a rare case of WEBINO caused by a unilateral midbrain infarction in which the patient experienced edema-related neurological deficits. This case provides evidence that early antiedema therapy may benefit patients with similar presentations.

Case report: A variant of wall-eyed bilateral internuclear ophthalmoplegia from unilateral pons infarction

“…Studies have shown that the disease is often associated with brainstem ischemia and hydrocephalus, immunotherapy of tumors, and diseases such as multiple sclerosis. This study summarized 39 case reports, including 42 WEBINO patients (Inocencio and Ballecer, 1985;Lana et al, 1990;Fay and Strominger, 1999;Korkmaz et al, 2002;Ozer et al, 2005;Chen and Lin, 2007;Kim et al, 2008;Matsumoto et al, 2008Matsumoto et al, , 2019Ushio et al, 2008;Jacob et al, 2010;Sierra-Hidalgo et al, 2010;Shinoda et al, 2011;Beh and Frohman, 2012;Jadhav and Prasad, 2012;Sakamoto et al, 2012;Bar et al, 2014;Chakravarthi et al, 2014;de Mora et al, 2014;Mathis et al, 2014;Muralidhar et al, 2014;Nakajima et al, 2014;Toufeeq and Dave, 2014;Agarwal et al, 2015;Ljevak et al, 2015;Man et al, 2015;de Souza et al, 2017;Sajjadi et al, 2017;Zou and Chen, 2017;Keereman et al, 2018;Papageorgiou et al, 2018;Im et al, 2020;Vázquez-Justes et al, 2020;Yazdi et al, 2020;Ansari et al, 2021;Jo et al, 2021;Petrik et al, 2021;Sinha et al, 2021;Wako et al, 2022). The age range of the ...…”