WEBINO: A unique neuro-ophthalmological manifestation of the unilateral mid-brain cerebrovascular event

Abstract

WEBINO (wall eye intranuclear ophthalmoplegia) is a specific type of neuroophthalmological condition that occurs due to a lesion in the MLF (medial longitudinal fasciculus), which causes unique symptoms characterized by bilateral adduction (inward movement of the eyes) impairment. Still, the abduction (outward movement of the eyes) may be preserved, and nystagmus during abduction is seen along with severe exotropia (outward movement of the eyes). In this case report, we report a 65-year-old male with a sudden onset of double vision, which he noticed while watching television, associated with a certain degree of vision loss and right-sided weakness of the body. Upon investigation, his imaging revealed an ischemic lesion in the unilateral midbrain involving his MLF. Lessons learned from this case are: This case spotlights the need for recognizing the WEBINO in cases of cerebrovascular events. It points out that for early diagnosis and proper treatment of WEBINO to achieve better results, there is a low incidence of stroke as the cause, more research is required, or better prognosis and treatment strategies in patients of WEBINO. It also underlines the need of comprehensive treatment measures, such as risk factor reduction and rehabilitation, for improving recovery and preventing future cerebrovascular episodes.