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Review
. 2020 May;25(3):82-84.
doi: 10.1097/NRL.0000000000000271.

Wall-Eyed Bilateral Internuclear Ophthalmoplegia by Ischemic Stroke: Case Report and Literature Review

Akiyuki Uzawa  1 , Yorinobu Takeda  2 , Satoshi Kuwabara  1
Affiliations
Review

Wall-Eyed Bilateral Internuclear Ophthalmoplegia by Ischemic Stroke: Case Report and Literature Review

Akiyuki Uzawa et al. Neurologist. 2020 May.

Abstract

Introduction: Wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) is a rare symptom. Several studies have reported that a small brainstem lesion could cause WEBINO.

Case report: The authors present the case of an 88-year-old female individual who developed sudden-onset diplopia and gait disturbance. Neurological examination revealed WEBINO with convergence impairment, gaze-evoked upward nystagmus on upward gaze, and bilateral limb ataxia. Brain magnetic resonance imaging revealed a small paramedian pontine tegmentum infarction, responsible for the symptoms. A literature review of WEBINO in ischemic stroke revealed that most patients exhibited impaired convergence and other neurological symptoms.

Conclusion: Gaze-evoked upward nystagmus on upward gaze and bilateral limb ataxia accompanied by WEBINO due to a small brainstem lesion were the characteristic findings of our case.

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References

    1. Wu YT, Cafiero-Chin M, Marques C. Wall-eyed bilateral internuclear ophthalmoplegia: review of pathogenesis, diagnosis, prognosis and management. Clin Exp Optom. 2015;98:25–30.
    1. Takamatsu K, Ohta T. A case of infarction in the pontine tegmentum involving the bilateral MLF and unilateral paramedian pontine reticular formation. Rinsho Shinkeigaku. 1995;35:272–276.
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    1. Chen CM, Lin SH. Wall-eyed bilateral internuclear ophthalmoplegia from lesions at different levels in the brainstem. J Neuroophthalmol. 2007;27:9–15.
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