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Images in Neurology
March 2012

Rapid Reversal of Wall-Eyed Bilateral Internuclear Ophthalmoplegia

Author Affiliations

Author Affiliations: Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Arch Neurol. 2012;69(3):405. doi:10.1001/archneurol.2011.995

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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