Wall-eyed bilateral inter nuclear ophthalmoplegia with vertical gaze palsy

Chakravarthi, Sudheer; Kesav, Praveen; Khurana, Dheeraj

doi:10.1093/qjmed/hct021

Cited by 10 publications

(7 citation statements)

References 2 publications

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“…Wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) is a rare disorder associated with lesions in the midbrain tegmentum affecting the MLF bilaterally. 54,55 The distinguishing clinical features of WEBINO are bilateral exotropia on primary gaze and bilateral internuclear. 54,55 Pupillary and levator function, as well as vestibulo-ocular reflex, are often normal.…”

Section: Wall-eyed Bilateral Internuclear Ophthalmoplegia (Webino)mentioning

confidence: 99%

“…54,55 The distinguishing clinical features of WEBINO are bilateral exotropia on primary gaze and bilateral internuclear. 54,55 Pupillary and levator function, as well as vestibulo-ocular reflex, are often normal. 55 Despite inability to adduct past midline in saccade or smooth pursuit and severe limitations in vertical saccade and smooth pursuit, the full range of horizontal and vertical eye movements can be elicited in patients during oculocephalic maneuvering.…”

Section: Wall-eyed Bilateral Internuclear Ophthalmoplegia (Webino)mentioning

confidence: 99%

“…54,55 Pupillary and levator function, as well as vestibulo-ocular reflex, are often normal. 55 Despite inability to adduct past midline in saccade or smooth pursuit and severe limitations in vertical saccade and smooth pursuit, the full range of horizontal and vertical eye movements can be elicited in patients during oculocephalic maneuvering. 54 It is important to distinguish WEBINO from one-and-a-half syndrome, which presents with unilateral horizontal gaze palsy and intranuclear ophthalmoplegia, on the basis of dissociated abducting nystagmus, impaired convergence, and supranuclear vertical gaze palsy.…”

Section: Wall-eyed Bilateral Internuclear Ophthalmoplegia (Webino)mentioning

confidence: 99%

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Chameleons, red herrings, and false localizing signs in neurocritical care

Sursal

Bowers

et al. 2020

British Journal of Neurosurgery

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False localizing signs (FLS) and other misleading neurological signs have long been an intractable aspect of neurocritical care. Because they suggest an incorrect location or etiology of the pathological lesion, they have often led to misdiagnosis and mismanagement of the patient. Here, we reviewed the existing literature to provide an updated, comprehensive descriptive review of these difficult to diagnose signs in neurocritical care. For each sign presented, we discuss the non-false localizing presentation of symptoms, the common FLS or misleading presentation, etiology/pathogenesis of the sign, and diagnosis, as well as any other clinically relevant considerations. Within cranial neuropathies, we cover cranial nerves III, IV, V, VI, VII, VIII, as well as multiple cranial nerve involvement of IX, X, and XII. FLS ophthalmologic symptoms indicate diagnostically challenging neurological deficits, and here we discuss downbeat nystagmus, pingpong-gaze, one-and-a-half syndrome, and wall-eyed bilateral nuclear ophthalmoplegia (WEBINO). Cranial herniation syndromes are integral to any discussion of FLS and here we cover Kernohan's notch phenomenon, pseudo-Dandy Walker malformation, and uncal herniation. FLS in the spinal cord have also been relatively well documented, but in addition to compressive lesions, we also discuss newer findings in radiculopathy and disc herniation. Finally, pulmonary syndromes may sometimes be overlooked in discussions of neurological signs but are critically important to recognize and manage in neurocritical care, and here we discuss Cheyne-Stokes respiration, cluster breathing, central neurogenic hyperventilation, ataxic breathing, Ondine's curse, and hypercapnia. Though some of these signs may be rare, the framework for diagnosing and treating them must continue to evolve with our growing understanding of their etiology and varied presentations.

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Section: Wall-eyed Bilateral Internuclear Ophthalmoplegia (Webino)mentioning

confidence: 99%

Section: Wall-eyed Bilateral Internuclear Ophthalmoplegia (Webino)mentioning

confidence: 99%

Section: Wall-eyed Bilateral Internuclear Ophthalmoplegia (Webino)mentioning

confidence: 99%

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Chameleons, red herrings, and false localizing signs in neurocritical care

Sursal

Bowers

et al. 2020

British Journal of Neurosurgery

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“…Discussion WEBINO is a rare syndrome consisting of bilateral exotropia, bilateral internuclear ophtalmoplegia and impaired convergence. Anatomic basis of this condition is believed to be a combination of bilateral medial longitudinal fascicle (MLF) and medial rectus subnucleus (MRSN) damage, but is still unproven (1). This most often occurs in mesencephalic stroke.…”

Section: Questionmentioning

confidence: 99%

Bilateral ptosis with wall-eyed bilateral internuclear ophthalmoplegia and vertical gaze paralysis

et al. 2014

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“…Here the patient will have a bilateral exotropia on primary gaze, bilateral internuclear ophthalmoplegia with impaired convergence (Chakravarthi et al, 2013). Here the patient will have a bilateral exotropia on primary gaze, bilateral internuclear ophthalmoplegia with impaired convergence (Chakravarthi et al, 2013).…”

Section: Lesion Of the Abducent Nerve Nucleusmentioning

confidence: 99%

Abducent Nerve

Rea¹

2014

Clinical Anatomy of the Cranial Nerves

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Wall-eyed bilateral inter nuclear ophthalmoplegia with vertical gaze palsy

Cited by 10 publications

References 2 publications

Chameleons, red herrings, and false localizing signs in neurocritical care

Chameleons, red herrings, and false localizing signs in neurocritical care

Bilateral ptosis with wall-eyed bilateral internuclear ophthalmoplegia and vertical gaze paralysis

Abducent Nerve

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