Wall-Eyed Bilateral Internuclear Ophthalmoplegia (WEBINO) secondary to multifocal pontine infarction

SIUW Chin P, ABDUL AZIZ Hayati B, VASUDEVAN Suresh

Ophthalmology Department, Hospital Sultanah Aminah, Johor Bahru, Johor, Malaysia

ABSTRACT      

Wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) is a rare syndrome with manifestations of bilateral adduction deficits, and exotropia in the primary gaze position. A 58-year-old man with underlying of diabetes mellitus, hypertension and dyslipidemia presented with diplopia for one week duration that was associated with numbness of the lips and anterior tongue, vomiting and giddiness. Ocular examination revealed exotropia in primary gaze, more in the left eye and an adduction deficit in both eyes, nystagmus in the contralateral eye whilst attempting adduction in both eyes. Convergence was absent and the vertical gazes were limited with vertical gaze-evoked nystagmus. Magnetic resonance imaging showed multifocal infarction in the pons and medulla oblongata. The right vertebral artery signal was absent on angiography. The patient was diagnosed with WEBINO secondary to multifocal pontine infarction, which is a rare syndrome. The treatment was targeted on his underlying modifiable diseases and anticoagulant has been started.

Keywords: Pontine infarction, ophthalmoplegia, diplopia, ocular motility disorders

Correspondence author: Siuw, Chin P, Hospital Sultanah Aminah, Jalan Persiaran Abu Bakar Sultan, 80100, Johor Bahru, Johor, Malaysia. Tel: +607-2257000, E mail: schinp@yahoo.com

Brunei Int Med J. 2016; 12 (1): 38-41