A Case of Wall-Eyed Bilateral Internuclear Ophthalmoplegia (WEBINO) Syndrome Caused by Pontine Infarction

Ogawa Katsuhiko; Akimoto Takayoshi; Hara Makoto; Kamei Satoshi; Nakajima Hideto; Nomura Yasuyuki; Shigihara Shuntaro

doi:10.4264/numa.78.6_367

Case Reports:

A Case of Wall-Eyed Bilateral Internuclear Ophthalmoplegia (WEBINO) Syndrome Caused by Pontine Infarction

Katsuhiko Ogawa, Takayoshi Akimoto, Makoto Hara, Satoshi Kamei, Hideto Nakajima, Yasuyuki Nomura, Shuntaro Shigihara

Author information

Katsuhiko Ogawa [Japan]
Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan [Japan]
Takayoshi Akimoto [Japan]
Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan [Japan]
Makoto Hara [Japan]
Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan [Japan]
Satoshi Kamei [Japan]
Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan [Japan]
Hideto Nakajima [Japan]
Division of Neurology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan [Japan]
Yasuyuki Nomura [Japan]
Department of Otolaryngology-Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan [Japan]
Shuntaro Shigihara [Japan]
Department of Otolaryngology-Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan [Japan]

Keywords: Wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) syndrome, Electronystagmogram, Saccade, Paramedian pontine reticular formation, Medial longitudinal fasciculus

JOURNAL FREE ACCESS

2019 Volume 78 Issue 6 Pages 367-372

DOI https://doi.org/10.4264/numa.78.6_367

Details

Abstract

We report a case of a 50-year-old man with wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) syndrome caused by pontine infarction. The patient exhibited bilateral internuclear ophthalmoplegia with alternating exotropia and left hemiparesis. In an inattentive state, bilateral mild exotropia was noted. On magnetic resonance imaging, infarcts were detected in the right pontine base and the tegmentum on both sides. On electronystagmogram of saccade, the velocity in adduction and abduction was decreased bilaterally. Furthermore, the velocity in adduction was more decreased than that in abduction bilaterally. This result indicated that the medial longitudinal fasciculus (MLF) and the bilateral paramedian pontine reticular formation (PPRF) were impaired bilaterally in predominance of the MLF. Inhibition of the lateral rectus muscle depends on inhibitory burst neurons connected to the contralateral PPRF. This inhibitory function was considered to be related to adjustment of the forward gaze in the lateral eye.

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