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Images in Neurology |

Rapid Reversal of Wall-Eyed Bilateral Internuclear Ophthalmoplegia

Ashutosh Prabhakar Jadhav, MD, PhD; Sashank Prasad, MD
Arch Neurol. 2012;69(3):405. doi:10.1001/archneurol.2011.995.
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A 41-year-old man with cryptococcal meningitis was treated with intravenous antifungal agents and lumbar punctures. Four weeks later, the patient developed confusion and somnolence. Examination demonstrated wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) as well as upbeat and downbeat nystagmus (Figure, A and B; video). A computed tomographic scan revealed hydrocephalus (Figure, C), and an extraventricular drain was placed. Three days later, the patient had improved mental status and resolution of internuclear ophthalmoplegia (Figure, D and E) with residual gaze-holding nystagmus (video). A repeated computed tomographic scan showed reduced hydrocephalus (Figure, F).

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Figure. On presentation, the patient had limited adduction with rightward (A) and leftward (B) lateral gaze and a computed tomographic image showed enlargement of the temporal horns of the lateral ventricles and the fourth ventricle (C). Three days after an extraventricular drain was placed, bilateral ophthalmoplegia resolved with rightward (D) and leftward (E) gaze and a repeated computed tomographic scan showed decreased enlargement of all ventricles (F).




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