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

This article describes the case of a 68-year-old woman presenting with acute dizziness and double vision, diagnosed with wall-eyed bilateral internuclear ophthalmoplegia (WEBINO). She experienced unprovoked, nonpositional dizziness, and binocular double vision that improved with eye closure. Neurological examination showed right eye exotropia, left eye hypertropia, mild right eyelid ptosis, and impaired extraocular movements, especially in elevation and adduction. Diagnostic tests including blood work and cerebrospinal fluid analysis were largely normal, but brain magnetic resonance imagingindicated symmetric diffusion-weighted imaging brightening in the bilateral midbrain, suggesting an acute infarction. WEBINO, a rare neuro-ophthalmological disorder often linked to brainstem strokes or demyelinating diseases, is characterized by bilateral medial rectus weakness due to lesions in the medial longitudinal fasciculus. The case underscores the importance of thorough clinical and radiological evaluation in diagnosing atypical presentations of neuro-ophthalmological disorders, with management focused on treating the underlying cause and providing symptomatic relief for diplopia.