title: A 12-year-old African American girl with subacute bilateral ophthalmoplegia.
abstract: A twelve-year-old African-American female presented with two week history of progressively worsening headache and fatigue, and vision difficulties for the past week. The physical examination was normal. The neurological evaluation was normal, except for cranial nerves (CN) testing, which showed bilateral restriction of adduction (CN III) and up gaze (CN IV) motions, vertical nystagmus, and left side facial paresis of central origin (CN VII). The bilateral exotropia and ophthalmoplegia are characteristics of WEBINO (Wall-Eyed Bilateral Intranuclear Ophthalmoplegia) syndrome, associated to a brain stem structural lesion. The following causes were evaluated and ruled out: tumor, infection, ischemic stroke, non-infectious inflammation. Pediatric Acquired Demyelinating Syndromes were then considered. Neuromyelitis Optica was ruled out in the absence of neuritis and normal spinal cord MRI. The differential diagnosis between Clinically Isolated Syndrome and Acute Demyelinating Encephalomyelitis, causing an isolated brain stem syndrome, is discussed.
authors.affiliation: Department of Pediatrics, Drexel University College of Medicine, St. Christopher's Hospital for Children, Philadelphia, PA.
authors.forename: Amir
authors.initials: A
authors.lastname: Bar
authors.affiliation: Department of Radiology, Drexel University College of Medicine, St. Christopher's Hospital for Children, Philadelphia, PA.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Urbine
authors.affiliation: Department of Pediatrics, Drexel University College of Medicine, St. Christopher's Hospital for Children, Philadelphia, PA.
authors.forename: Yasmine
authors.initials: Y
authors.lastname: Bahora
authors.affiliation: Department of Surgery, Drexel University College of Medicine, St. Christopher's Hospital for Children, Philadelphia, PA.
authors.forename: Meghan
authors.initials: M
authors.lastname: Berkenstock
authors.affiliation: Department of Pediatrics, Drexel University College of Medicine, St. Christopher's Hospital for Children, Philadelphia, PA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Vodzak
authors.affiliation: Department of Pediatrics, Temple University School of Medicine, St. Christopher's Hospital for Children, Philadelphia, PA.
authors.forename: Hamalatha
authors.initials: H
authors.lastname: Guruprasad
authors.affiliation: Department of Pediatrics, Temple University School of Medicine, St. Christopher's Hospital for Children, Philadelphia, PA.
authors.forename: Manisha
authors.initials: M
authors.lastname: Sinha
authors.affiliation: Department of Pediatrics, Temple University School of Medicine, St. Christopher's Hospital for Children, Philadelphia, PA.
authors.forename: Thair
authors.initials: T
authors.lastname: Abed
authors.affiliation: Department of Pediatrics, Drexel University College of Medicine, St. Christopher's Hospital for Children, Philadelphia, PA. Electronic address: alegido@drexelmed.edu.
authors.forename: Agustín
authors.initials: A
authors.lastname: Legido
mesh_terms: D001741:Black or African American; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D002648:Child; D003937:Diagnosis, Differential; D004673:Encephalomyelitis, Acute Disseminated / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D009886:Ophthalmoplegia / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology; D014057:Tomography, X-Ray Computed