[Case of multiple sclerosis with WEBINO syndrome]

Area of Science:

• Neuroscience
• Ophthalmology
• Neurology

Background:

• Multiple Sclerosis (MS) is a chronic demyelinating disease of the central nervous system.
• Wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) syndrome is a rare condition characterized by specific eye movement abnormalities.

Observation:

• A 50-year-old man with secondary progressive MS presented with progressive double vision and tetraparesis.
• Clinical examination revealed bilateral facial nerve palsy, pseudobulbar palsy, spastic tetraparesis, and characteristic ocular motor deficits consistent with WEBINO syndrome.
• MRI demonstrated a pontine tegmentum lesion without enhancement.

Findings:

• The patient's ocular findings, including bilateral adduction deficits and exotropia, were attributed to impaired medial longitudinal fasciculus and paramedian pontine reticular formation.
• Despite the typical association of WEBINO with stroke, this case demonstrates its occurrence in a demyelinating disease context.

Implications:

• This case suggests that demyelinative lesions in MS can lead to persistent WEBINO syndrome.
• Understanding this association is crucial for accurate diagnosis and management of neurological disorders affecting ocular motility.