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

抄録

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.