title: [Case of wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) syndrome with cerebellar ataxia and facial dysesthesia].
abstract: We report an 85-year-old man presenting with wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) syndrome with cerebellar ataxia and facial dysesthesia. He experienced an abrupt onset of double vision and exotropia of the right eye with unsteady gait and dysesthesia around upper lip. He was admitted to our hospital ten days after the onset of the double vision. On admission, he presented with WEBINO, left limb ataxia, and dysesthesia around upper lip on the right side. His exotropia was prominent on the right side. Diffusion weighted images of MRI revealed a high intensity lesion in the paramedian pontine tegmentum involving bilateral medial longitudinal fasciculus (MLF), consistent with acute ischemic lesion. Four months after the onset, the WEBINO persisted, without cerebellar ataxia and facial dysesthesia. Putative lesions of the WEBINO, cerebellar ataxia and facial dysesthesia were bilateral MLF, left superior cerebellar peduncle and trigeminothalamic tract, respectively, which were broader than the MRI lesion. Neurological examination is critical for evaluation of accurate ischemic area.
authors.affiliation: Department of Neurology and Anti-aging Medicine, National Defense Medical College.
authors.forename: Masato
authors.initials: M
authors.lastname: Kadoya
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Onoue
authors.forename: Akiko
authors.initials: A
authors.lastname: Kadoya
authors.forename: Mana
authors.initials: M
authors.lastname: Higashihara
authors.forename: Katsunori
authors.initials: K
authors.lastname: Ikewaki
authors.forename: Kenichi
authors.initials: K
authors.lastname: Kaida
mesh_terms: D000369:Aged, 80 and over; D002524:Cerebellar Ataxia / Q000209:etiology*; D002544:Cerebral Infarction / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D004172:Diplopia / Q000209:etiology; D005099:Exotropia / Q000209:etiology; D006801:Humans; D008046:Lip; D008279:Magnetic Resonance Imaging; D008297:Male; D015835:Ocular Motility Disorders / Q000175:diagnosis* / Q000209:etiology*; D010292:Paresthesia / Q000175:diagnosis* / Q000209:etiology*; D065821:Pontine Tegmentum / Q000473:pathology; D020530:Subthalamus / Q000473:pathology; D013577:Syndrome