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Wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) - midbrain infarct

Case contributed by Paresh K Desai
Diagnosis almost certain

Presentation

Patient with wall eyed bilateral internuclear ophthalmoplegia

Patient Data

Age: 55 years

Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.

MRI brain reveals a small paramedian mid-brain infarct.

Figure 1: 

  • FLAIR axial image (A) through midbrain – No abnormal signal intensity in the midbrain
  • T2_3D axial image (B) through midbrain – subtle hyperintense signal in the left paramedian midbrain
  • this lesion shows diffusion restriction on DWI (horizontal arrow on C)
  • ADC map (vertical arrow on D) which is classic of acute infarct

Figure 2: Acute infarcts in the left cerebellar hemisphere on a lower section through cerebellum seen as areas of diffusion restriction on DWI.

Case Discussion

Final diagnosis: mid-brain and cerebellar infarcts.

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