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Jung JW, Kim YE, Oh SY, Lee HJ. Neuro-Behçet Disease Presenting with Wall-Eyed Bilateral Internuclear Ophthalmoplegia Syndrome: A Case Report. KOREAN JOURNAL OF OPHTHALMOLOGY 2024; 38:88-90. [PMID: 38360522 PMCID: PMC10869429 DOI: 10.3341/kjo.2023.0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/27/2023] [Accepted: 12/29/2023] [Indexed: 02/17/2024] Open
Affiliation(s)
- Jin Wook Jung
- Department of Ophthalmology, Jeonbuk National University Hospital, Jeonju,
Korea
| | - Young-Eun Kim
- Department of Ophthalmology, Jeonbuk National University Hospital, Jeonju,
Korea
| | - Sun-Young Oh
- Department of Neurology, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju,
Korea
- Research Institute of Clinical Medicine of Jeonbuk National University, Jeonbuk National University Hospital, Jeonju,
Korea
| | - Haeng-Jin Lee
- Department of Ophthalmology, Jeonbuk National University Hospital, Jeonju,
Korea
- Research Institute of Clinical Medicine of Jeonbuk National University, Jeonbuk National University Hospital, Jeonju,
Korea
- Department of Ophthalmology, Jeonbuk National University Medical School, Jeonju,
Korea
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Kudo Y, Takahashi K, Johkura K. Downbeat Nystagmus Associated With Wall-Eyed Bilateral Internuclear Ophthalmoplegia in Paramedian Pontine Tegmentum Infarction. J Neuroophthalmol 2023; 43:e331-e333. [PMID: 35234687 DOI: 10.1097/wno.0000000000001502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Yosuke Kudo
- Department of Neurology (YK, KJ) and Clinical Laboratory (KT), Yokohama Brain and Spine Center, Yokohama, Japan
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Kim A, Jung YJ, Yoo D, Shin C, Jeong SH. Wall-Eyed Bilateral Internuclear Ophthalmoplegia Syndrome in a Patient With Progressive Supranuclear Palsy: A Case Report and Literature Review. J Mov Disord 2023; 16:227-230. [PMID: 37258284 DOI: 10.14802/jmd.22056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 04/03/2023] [Indexed: 06/02/2023] Open
Affiliation(s)
- Aryun Kim
- Department of Neurology, Chungbuk National University Hospital, Cheongju, Korea
| | - Yu Jin Jung
- Department of Neurology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dallah Yoo
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Korea
| | - Chaewon Shin
- Department of Neurology, Chungnam National University Sejong Hospital, Sejong, Korea
- Department of Neurology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Seong-Hae Jeong
- Department of Neurology, Chungnam National University College of Medicine, Daejeon, Korea
- Department of Neurology, Chungnam National University Hospital, Daejeon, Korea
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Zainal Abidin N, Tuan Jaffar TN, Ahmad Tajudin LS. Wall-Eyed Bilateral Internuclear Ophthalmoplegia as an Early Presentation of Multiple Sclerosis. Cureus 2023; 15:e36835. [PMID: 37123672 PMCID: PMC10147486 DOI: 10.7759/cureus.36835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2023] [Indexed: 03/31/2023] Open
Abstract
Wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) is a rare neuro-ophthalmological condition in which there is ocular motility impairment characterized by bilateral adduction deficiencies, bilateral abducting nystagmus, and exotropia in primary gaze, and is often associated with multiple sclerosis (MS). This report describes a young female who presented with sudden onset of binocular diplopia and alternating exotropia for two days duration, which was associated with a history of intermittent headaches for one year before presenting complaints. Examination revealed alternating exotropia on the primary gaze with bilateral limitation of adduction and bilateral nystagmus on abduction. Other ocular and neurological examinations were unremarkable. Neuroimaging showed multiple white matter lesions that were consistent with demyelinating disease. Her symptoms completely resolved after the initiation of intravenous corticosteroid therapy. However, she developed left upper limb numbness four months later, and a repeat magnetic resonance imaging (MRI) of the brain showed the presence of multiple new brain lesions. Subsequently, she was diagnosed with MS and started on immunotherapy. Her symptoms resolved, with no residual ophthalmoplegia or any neurological symptoms.
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A rare case of a wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) syndrome in a patient with cutaneous lupus erythematosus after COVID-19 infection. J Neurol 2023; 270:1224-1228. [PMID: 36576573 PMCID: PMC9795426 DOI: 10.1007/s00415-022-11548-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022]
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Simmons J, Rhodes M. Conservative and Surgical Management of Unilateral and Bilateral Internuclear Ophthalmoplegia (INO)—A Retrospective Analysis. BRITISH AND IRISH ORTHOPTIC JOURNAL 2022; 18:152-158. [DOI: 10.22599/bioj.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2022] Open
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Abstract
Exotropia (XT) in internuclear ophthalmoplegia (INO) is a difficult problem to treat. The purpose of this study is to describe surgical approaches in treating INO and glean insight into various pre-operative factors that may affect outcomes for XT in INO. We conducted a retrospective review from 1 January 1995 - 5 January 2021 and identified seven patients with INO who underwent strabismus surgery for XT. Patient age, sex, etiology of INO, pre-operative alignment and sensorimotor exam, presence of diplopia, surgery performed, subsequent surgeries, use of adjustable sutures, post-operative alignment, presence of post-operative diplopia, presence of post-operative diplopia with use of prism correction, and length of follow-up were all collected. Initial surgeries undertaken included unilateral medial rectus (MR) plication and lateral rectus (LR) recession, bilateral medial rectus (MR) plications or resections, or bilateral MR plications combined with either unilateral or bilateral LR recessions. Chart review yielded ten charts, however two were excluded due to manifest esotropia (ET), and one was excluded due to incomplete records. Seven total patients were used in final analysis. The cohort age range was from 29 to 79 years. Pre-operative horizontal distance alignment ranged from 35 to 95 XT with an average exodeviation of 67.8 ± 22.6 prism diopters (PD). Horizontal adduction deficit ranged from -1 to -4 and was present bilaterally in all patients. A variety of initial surgical approaches were undertaken. After two muscle surgeries, distance deviation had an average change of 57.3 PD. After three muscle surgeries, distance deviation had an average change of 75 PD. After four muscle surgeries, distance deviation had an average change of 60 PD. Three patients required additional surgery for XT. Time to follow-up ranged from 1 to 58 months. Horizontal distance alignment in primary gaze at latest follow-up ranged from 30 ET to 30 XT with an average of 0 (orthotropia) ± 16.0 PD. One patient had a consecutive esotropia of 30 PD, one had a persistent exotropia of 30 PD, and five patients were orthotropic at distance. All patients reported relief of diplopia in primary gaze at near and distance either with or without use of prism. Horizontal ductions improved to some degree in all patients. Horizontal rectus surgery can treat many cases of XT in INO. Surgeons should consider INO etiology and concomitant vertical deviations when considering surgery. The degree of pre-operative adduction limitation is another important factor, though did not always dictate final motor and sensory outcomes.
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Affiliation(s)
- Daniel G. Nelson
- Department of Ophthalmology, Emory University, Atlanta, Georgia, United States
| | - Jason H. Peragallo
- Department of Ophthalmology, Emory University, Atlanta, Georgia, United States,Department of Pediatrics, Emory University, Atlanta, Georgia, United States
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Petrik S, Lambeck J, Bardutzky J. In Reply. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:295. [PMID: 35836343 PMCID: PMC9437836 DOI: 10.3238/arztebl.m2022.0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Stephan Petrik
- Klinik für Neurologie und Neurophysiologie Uniklinikum Freiburg
| | - Johann Lambeck
- Klinik für Neurologie und Neurophysiologie Uniklinikum Freiburg
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Ansari J, Eltigani Mohmmed Y, Ghazal-Aswad S, Ansari H, Akhter SMJ, Hassoun Hadid O, Rizwan S, Almazrouei R, Dawoud E, Azribi F, Elhasin H, Kumar P, Al Sumaida AR, Al-Qawasmeh K, Glaholm J, Hochmair MJ, Hussain S, Balaraj K. Rare case of chemotherapy-refractory metastatic vaginal squamous cell carcinoma with complete response to concurrent pembrolizumab and radiotherapy- case report and literature review. Gynecol Oncol Rep 2021; 38:100878. [PMID: 34926759 PMCID: PMC8651786 DOI: 10.1016/j.gore.2021.100878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 09/11/2021] [Accepted: 10/04/2021] [Indexed: 12/12/2022] Open
Abstract
Metastatic vaginal cancer, rare cancer with limited treatment options. Pembrolizumab and radiotherapy led to complete response in a patient with metastatic vaginal cancer. Wall-eyed bilateral internuclear ophthalmoplegia, a new immune related adverse event.
Primary vaginal cancer is a rare malignancy with a lack of international guidelines and supporting clinical trial evidence to guide decision making. Historical results have shown poor outcomes with chemotherapy for stage IVB vaginal squamous cell carcinoma (SCC). The evolving role of checkpoint inhibitors in rare gynaecological cancers prompted us to investigate the role of pembrolizumab in this setting. The efficacy of pembrolizumab in vaginal SCC has never been investigated in any clinical trial. There is established data to support the use of concurrent chemoradiotherapy in gynaecological cancers, however, the data for concurrent use of immunotherapy and radiotherapy is still lacking but is the subject of several clinical trials. We herein present the first reported case of chemotherapy refractory vaginal SCC with complete response to pembrolizumab and concurrent pelvic radiotherapy. We also present wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) as a rare but new immune related adverse event.
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Affiliation(s)
- Jawaher Ansari
- Department of Medical Oncology, Tawam Hospital, Al Ain, United Arab Emirates
| | | | - Saad Ghazal-Aswad
- Department of Gynaecology, Tawam Hospital, Al Ain, United Arab Emirates
| | - Hidayath Ansari
- Department of Radiology and Nuclear Medicine, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Syed M J Akhter
- Department of Pathology, Tawam Hospital, Al Ain, United Arab Emirates
| | - Omar Hassoun Hadid
- Department of Ophthalmology, Tawam Hospital, Al Ain, United Arab Emirates
| | - Syed Rizwan
- Department of Radiology and Nuclear Medicine, Tawam Hospital, Al Ain, United Arab Emirates
| | - Raya Almazrouei
- Department of Endocrinology, Tawam Hospital, Al Ain, United Arab Emirates
| | - Emad Dawoud
- Department of Medical Oncology, Tawam Hospital, Al Ain, United Arab Emirates
| | - Fathi Azribi
- Department of Medical Oncology, Tawam Hospital, Al Ain, United Arab Emirates
| | - Heba Elhasin
- Department of Neurology, Tawam Hospital, Al Ain, United Arab Emirates
| | - Pawan Kumar
- Department of Medical Oncology, Tawam Hospital, Al Ain, United Arab Emirates
| | | | - Khaled Al-Qawasmeh
- Department of Medical Oncology, Tawam Hospital, Al Ain, United Arab Emirates
| | - John Glaholm
- Institute of Cancer Research, London SM2 5NG, United Kingdom
| | - M J Hochmair
- Department of Respiratory & Critical Care Medicine, Karl Landsteiner Institute of Lung Research & Pulmonary Oncology, Krankenhaus Nord, 3500 Vienna, Austria
| | - Syed Hussain
- Department of oncology and metabolism, Room 228, 2nd Floor, Broomcross Building, Weston Park Hospital, Whitham Road, Sheffield S10 2SJ, United Kingdom
| | - Khalid Balaraj
- Department of Radiation Oncology, Tawam Hospital, Al Ain, United Arab Emirates
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Bennetto L, Lueck CJ. Wall-eyed bilateral internuclear ophthalmoplegia (WEBINO): what does it mean to be wall-eyed? Pract Neurol 2021; 22:4-5. [PMID: 34836932 DOI: 10.1136/practneurol-2021-003157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Luke Bennetto
- Department of Neurology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
- Institute of Clinical Neurosciences, University of Bristol, Bristol, UK
| | - Christian J Lueck
- Department of Neurology, Canberra Hospital, Canberra, Australian Capital Territory, Australia
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Chen T. Wall-eyed bilateral internuclear ophthalmoplegia associated with etanercept. Pract Neurol 2021; 22:71-72. [PMID: 34353861 DOI: 10.1136/practneurol-2021-003064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Tychicus Chen
- Division of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Brosset C, Nguyen Quang H, Tyson T, Pruvot F, Do Van T, Nguyen The H. Eiffel tower in Hanoi. Rev Neurol (Paris) 2021; 177:1011-1012. [PMID: 34215430 DOI: 10.1016/j.neurol.2020.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/23/2020] [Accepted: 12/29/2020] [Indexed: 11/24/2022]
Affiliation(s)
- C Brosset
- Neurology Department, Hanoi French Hospital, 1 Phuong Mai street, Dong Da, Hanoi, Vietnam.
| | - H Nguyen Quang
- Department of Internal Medicine, Hanoi French Hospital, 1 Phuong Mai street, Dong Da, Hanoi, Vietnam
| | - T Tyson
- Emergency Department, Hanoi French Hospital, 1 Phuong Mai street, Dong Da, Hanoi, Vietnam
| | - F Pruvot
- Emergency Department, Hanoi French Hospital, 1 Phuong Mai street, Dong Da, Hanoi, Vietnam
| | - T Do Van
- Radiology Department, Hanoi French Hospital, 1 Phuong Mai street, Dong Da, Hanoi, Vietnam
| | - H Nguyen The
- Radiology Department, Hanoi French Hospital, 1 Phuong Mai street, Dong Da, Hanoi, Vietnam
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Zhou C, Xu Z, Huang B, He Y, Zhu Y, Zhao Y, Wang P. Caudal paramedian midbrain infarction: a clinical study of imaging, clinical features and stroke mechanisms. Acta Neurol Belg 2021; 121:443-450. [PMID: 31456122 DOI: 10.1007/s13760-019-01204-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 08/20/2019] [Indexed: 12/27/2022]
Abstract
Caudal paramedian midbrain infarction (CPMI) is an extremely rare form of ischemic stroke and related clinical studies are scarce. Our aim is to investigate the clinical features, neuroradiological findings and stroke etiology of CPMI. We conducted a retrospective study of 12 patients with CPMI, confirmed by diffusion-weighted MRI from 6820 cerebral infarction patients at our stroke center from January 2012 to August 2018. Experienced neurologists evaluated the clinical manifestations, neuroimaging findings and stroke mechanisms. Twelve patients (11 men, 1 woman) aged 42-81 years old met the study inclusion criteria. Seven patients had a unilateral infarction (two right-sided, five left-sided) and five had bilateral infarctions. Sagittal image showed a backward oblique sign in the lower level of the midbrain. Significantly, the bilateral CPMIs presented with a characteristic "V-shaped" appearance in the axial MRI. All patients presented with bilateral cerebellar dysfunction which included dysarthric speech, truncal or gait ataxia and four-limb ataxia. In addition, diplopia and internuclear ophthalmoplegia were frequently encountered in CPMI. Five (41.7%) patients were classified with large artery atherosclerosis, four (33.3%) with small vessel disease, two (16.7%) with cardiogenic embolism, and one (8.3%) with undetermined etiology. CPMI is a rare cerebrovascular disease that destroys the Wernekink commissure, medial longitudinal fasciculi and other adjacent structures. It is characterized by bilateral cerebellar ataxia and eye movement disorders, mainly internuclear ophthalmoplegia. A distinct "V-shaped" radiological feature can be seen in bilateral CPMI patients. The primary mechanisms of unilateral CPMI involve small vessel disease. The underlying stroke mechanisms of bilateral CPMI are either large artery atherosclerosis disease or cardiac embolism.
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Wall-Eyed Bilateral Internuclear Ophthalmoplegia by Ischemic Stroke: Case Report and Literature Review. Neurologist 2021; 25:82-84. [PMID: 32358467 DOI: 10.1097/nrl.0000000000000271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) is a rare symptom. Several studies have reported that a small brainstem lesion could cause WEBINO. CASE REPORT The authors present the case of an 88-year-old female individual who developed sudden-onset diplopia and gait disturbance. Neurological examination revealed WEBINO with convergence impairment, gaze-evoked upward nystagmus on upward gaze, and bilateral limb ataxia. Brain magnetic resonance imaging revealed a small paramedian pontine tegmentum infarction, responsible for the symptoms. A literature review of WEBINO in ischemic stroke revealed that most patients exhibited impaired convergence and other neurological symptoms. CONCLUSION Gaze-evoked upward nystagmus on upward gaze and bilateral limb ataxia accompanied by WEBINO due to a small brainstem lesion were the characteristic findings of our case.
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Lopes D, Loureiro T, Machado I, Campos N. Non-Paralytic Pontine Exotropia as a Predominant Sign of Brainstem Infarction - A Case Report. Neuroophthalmology 2020; 45:317-319. [PMID: 34483409 DOI: 10.1080/01658107.2020.1755699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
The association of internuclear ophthalmoplegia (INO) with exotropia in the contralateral eye is a rare finding, known as non-paralytic pontine exotropia (NPPE). We report a case of an 80-year-old woman with acute onset of diplopia on admission who presented with left eye exotropia with left-beating nystagmus whilst fixating with the right eye and inability to adduct the right eye on left gaze. Brain magnetic resonance imaging showed two small areas of vertebrobasilar territory ischaemic stroke, one beneath the inferior portion of the aqueduct and another in the right occipital lobe. Our case highlights an interesting clinical manifestation of brainstem infarction that, along with ocular motility examination, allowed us to review its pathophysiology, including the influence of the contralateral paramedian pontine reticular formation stimulation in the mechanism of contralateral exotropia in NPPE. The fast clinical resolution of these cases can explain the scarcity of NPPE reports.
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Affiliation(s)
- Diogo Lopes
- Department of Ophthalmology, Garcia De Orta Hospital, Almada, Portugal
| | - Tomás Loureiro
- Department of Ophthalmology, Garcia De Orta Hospital, Almada, Portugal
| | - Inês Machado
- Department of Ophthalmology, Garcia De Orta Hospital, Almada, Portugal
| | - Nuno Campos
- Department of Ophthalmology, Garcia De Orta Hospital, Almada, Portugal
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Vázquez-Justes D, Martín-Cucó A, Gallego-Sánchez Y, Vicente-Pascual M. WEBINO syndrome (wall-eyed bilateral internuclear ophthalmoplegia) secondary to ischemic stroke, about a case. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2020; 95:205-208. [PMID: 32088083 DOI: 10.1016/j.oftal.2019.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/11/2019] [Accepted: 12/17/2019] [Indexed: 06/10/2023]
Abstract
WEBINO (wall-eyed bilateral internuclear ophthalmoplegia) syndrome is characterized by bilateral adduction impairment, nystagmus of the abducting eye, and primary gaze exotropia. We present the case of a 68 year-old man who was initially attended in emergency department with sudden onset diplopia. Neurological exploration revealed WEBINO and gait ataxia. Relevant medical history included liver transplantation and subsequent tacrolimus prescription. Complementary exams revealed ischemic lesion in mesencephalic tegmentum, involving medial longitudinal fasciculus and pretectal area. WEBINO syndrome is unfrequent. Among its etiologies, ischemic and demyelinating are the most frequent. In our case, iatrogenic etiology was also considered. Clinical recognition of this syndrome is required to perform adequate exams in order to reach diagnosis.
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Affiliation(s)
- D Vázquez-Justes
- Servicio de Neurología, Hospital Universitari Arnau de Vilanova, Lleida, España
| | - A Martín-Cucó
- Centro de Atención Primaria Bordeta-Magraners, Lleida, España
| | - Y Gallego-Sánchez
- Servicio de Neurología, Hospital Universitari Arnau de Vilanova, Lleida, España
| | - M Vicente-Pascual
- Servicio de Neurología, Hospital Universitari Arnau de Vilanova, Lleida, España.
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Hai S, Elkbuli A, Kinslow K, McKenney M, Boneva D. When "looks" can be deceiving - Internuclear ophthalmoplegia after mild traumatic brain injury: Case report and literature review. Int J Surg Case Rep 2019; 63:19-22. [PMID: 31539826 PMCID: PMC6796632 DOI: 10.1016/j.ijscr.2019.08.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 08/24/2019] [Indexed: 11/25/2022] Open
Abstract
We report a case of WEMINO caused by mild traumatic brain injury, presenting with typical left ocular manifestations. CT scan of brain was noncontributory, but MRI managed to delineate the site of injury in the MLF in the left temporo-occipital white matter. Although more common in demyelinating diseases, clinicians should be cognizant of this syndrome in mild TBI patients that have ocular exotropia.
Introduction Walled-eyed monocular internuclear ophthalmoplegia (WEMINO) syndrome is a sub-variant of internuclear ophthalmoplegia (INO) and involves the same clinical findings with the addition of exotropia of the ipsilateral eye. Causes typically include multiple sclerosis (MS) and ischemia (hemorrhagic or embolic) but can be secondary to blunt trauma as seen in our presented case. Presentation of case A 27-year-old man presented with new-onset visual changes, diplopia, and strabismus following a motor vehicle collision. Physical exam showed left ocular exotropia and slight hypertropia on forward gaze with deficiency of left convergence and disconjugate eye movements on horizontal gaze with right nystagmus on rightward gaze. Imaging showed hyperintensities in the right middle cerebellar peduncle and left temporal-occipital white matter likely consistent with diffuse axonal injury but otherwise nonspecific. The patient was treated conservatively with left eyepatch and exhibited improvement of exotropia and diplopia at 1 week follow up. Discussion Common causes of WEMINO syndrome include MS and ischemia with no prior reports, to our knowledge, being secondary to the blunt trauma seen in our case. Patients with WEMINO present with the typical signs of failure of ipsilateral adductive movement during lateral along with ipsilateral exotropia. Management involves treating the underlying disorder, if possible, with conservative measures with traumatic origins. Conclusion Until now, WEMINO syndrome secondary to trauma has not been previously documented. Our patient was effectively treated with conservative measures alone.
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Affiliation(s)
- Shaikh Hai
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States
| | - Adel Elkbuli
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States.
| | - Kyle Kinslow
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States; University of South Florida, Tampa, FL, United States
| | - Mark McKenney
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States; University of South Florida, Tampa, FL, United States
| | - Dessy Boneva
- Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States; University of South Florida, Tampa, FL, United States
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Al Jabri S, Kirkham J, Rowe FJ. Development of a core outcome set for amblyopia, strabismus and ocular motility disorders: a review to identify outcome measures. BMC Ophthalmol 2019; 19:47. [PMID: 30736755 PMCID: PMC6368710 DOI: 10.1186/s12886-019-1055-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 01/29/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Core Outcome Sets (COS) are defined as the minimum sets of outcomes that should be measured and reported in all randomised controlled trials to facilitate combination and comparability of research. The aim of this review is to produce an item bank of previously reported outcome measures from published studies in amblyopia, strabismus and ocular motility disorders to initiate the development of COS. METHODS A review was conducted to identify articles reporting outcome measures for amblyopia, strabismus and ocular motility disorders. Using systematic methods according to the COMET handbook we searched key electronic bibliographic databases from 1st January 2011 to 27th September 2016 using MESH terms and alternatives indicating the different subtypes of amblyopia, strabismus and ocular motility disorders in relation to treatment outcomes and all synonyms. We included Cochrane reviews, other systematic reviews, controlled trials, non-systematic reviews and retrospective studies. Data was extracted to tabulate demographics of included studies, primary and secondary outcomes, methods of measurement and their time points. RESULTS A total of 142 studies were included; 42 in amblyopia, 33 in strabismus, and 68 in ocular motility disorders (one study overlap between amblyopia and strabismus). We identified ten main outcome measure domains for amblyopia, 14 for strabismus, and ten common "visual or motility" outcome measure domains for ocular motility disorders. Within the domains, we found variable nomenclature being used and diversity in methods and timings of measurements. CONCLUSION This review highlights discrepancies in outcome measure reporting within published literature for amblyopia, strabismus and ocular motility and it generated an item bank of the most commonly used and reported outcome measures for each of the three conditions from recent literature to start the process of COS development. Consensus among all stakeholders including patients and professionals is recommended to establish a useful COS.
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Affiliation(s)
- Samia Al Jabri
- Department of Health Services Research, University of Liverpool, Waterhouse Building Block B, 2nd Floor, 1-3 Brownlow Street, L69 3GL Liverpool, UK
| | - Jamie Kirkham
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Fiona J. Rowe
- Department of Health Services Research, University of Liverpool, Waterhouse Building Block B, 2nd Floor, 1-3 Brownlow Street, L69 3GL Liverpool, UK
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Wall-eyed Bilateral Internuclear Ophthalmoplegia (WEBINO) in a Patient With Idiopathic Intracranial Hypertension. Neurologist 2018; 23:157-159. [PMID: 30169368 DOI: 10.1097/nrl.0000000000000192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) is a variant syndrome of internuclear ophthalmoplegia, consisting of primary gaze exotropia, adduction impairment, nystagmus of the abducting eye, and vertical gaze-evoked nystagmus. It seems to be most frequently associated with multiple sclerosis, although other etiologies such as brainstem ischemia or hydrocephalus have also been described. CASE REPORT We report the case of a 25-year-old woman who presented with subacute progressive oculomotor disturbances, resulting in the development of a WEBINO over a few days. Fundoscopy showed papilledema first in the right and afterwards also in the left eye. Brain magnetic resonance imaging was normal. Lumbar puncture demonstrated an opening pressure of 38 cm H2O, without pleiocytosis and with normal protein. As no other cause of intracranial hypertension could be identified by imaging or extensive biochemical testing, the patient was treated with acetazolamide for idiopathic intracranial hypertension. As there was further progression despite increase of acetazolamide dosing, more aggressive therapy was pursued, and a ventriculoperitoneal shunt was placed by our neurosurgeons. Clinical follow-up showed progressive recovery of normal oculomotor function and disappearance of papilledema over the course of 6 weeks. CONCLUSIONS To our knowledge this is the first case description of a patient with WEBINO and idiopathic intracranial hypertension. The diagnosis is supported by the very high opening pressure, the absence of neuroimaging abnormalities, the papilledema, and the response to ventriculoperitoneal drainage.
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Isolated bilateral internuclear ophthalmoplegia due to lacunar infarction. Neurol Sci 2018; 39:795-796. [PMID: 29170848 DOI: 10.1007/s10072-017-3199-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 11/16/2017] [Indexed: 10/18/2022]
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Zou Z, Chen W. Can Wernekink commissure syndrome and wall-eyed bilateral internuclear ophthalmoplegia be ascribed to neuromyelitis optica spectrum disorder? Neurol Sci 2017; 38:2053-2055. [PMID: 28681309 DOI: 10.1007/s10072-017-3041-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 06/19/2017] [Indexed: 12/30/2022]
Affiliation(s)
- Zhangyu Zou
- Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Weian Chen
- Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang Street, Ouhai District, Wenzhou, 325000, China.
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Sajjadi M, Sonbolestan SA, Abtahi SMA, Abtahi ZS. Transposition surgery for WEBINO. Int Ophthalmol 2016; 37:271-274. [DOI: 10.1007/s10792-016-0235-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 04/11/2016] [Indexed: 11/24/2022]
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