Presentation of Bilateral Midbrain Infarction as Wall-eyed Bilateral Internuclear Ophthalmoplegia: A Case Report

Area of Science:

• Neuroscience
• Ophthalmology

Background:

• Wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) is a rare neuro-ophthalmological disorder.
• It is often associated with brainstem strokes or demyelinating diseases.
• WEBINO is characterized by bilateral medial rectus muscle weakness due to lesions in the medial longitudinal fasciculus.

Purpose of the Study:

• To describe a case of acute WEBINO presenting with dizziness and double vision.
• To highlight the diagnostic challenges and importance of thorough evaluation for atypical neuro-ophthalmological presentations.

Main Methods:

• Case report of a 68-year-old woman with acute dizziness and diplopia.
• Clinical examination including neurological assessment of extraocular movements.
• Diagnostic workup including blood tests, cerebrospinal fluid analysis, and brain MRI.

Main Results:

• The patient was diagnosed with WEBINO.
• Brain MRI revealed symmetric diffusion-weighted imaging abnormalities in the bilateral midbrain, indicative of acute infarction.
• Neurological examination showed exotropia, hypertropia, ptosis, and impaired adduction and elevation.

Conclusions:

• This case highlights an atypical presentation of WEBINO.
• Prompt clinical and radiological assessment is crucial for diagnosing such rare neuro-ophthalmological conditions.
• Management involves addressing the underlying cause and managing diplopia symptoms.