Abstract Details

Title Wall-Eyed Monocular Internuclear Ophthalmoplegia (WEMINO) and Millard-Gubler Syndromes in a Patient with Isolated Pontine Infarction: Topographic, Oculomotor, and Radiological Analysis of Two Very Uncommon Conditions.

Topic Neuro-ophthalmology/Neuro-otology

Presentation(s) P9 - Poster Session 9 (12:00 PM-1:00 PM)

Poster/Presentation
Number 5-013

Objective To analyze a unique case of an isolated pontine infarct that simultaneously developed WEMINO (wall-eyed internuclar ophthalmoplegia) and Millard-Gubler (MG) syndromes along with central acute vertigo. We approach and analyze the lesion from clinical, topographic, and radiological perspectives; emphasizing the vestibular and oculomotor bedside examination.

Background

MG, is a crossed pontine syndrome from damage to the ventromedial region of the pons, the corticospinal tract, the intrapontine fascicle of the seventh cranial nerve and, occasionally, the abducens nerve fibers. The WEMINO syndrome is a rare pre-nuclear variant of internuclear ophthalmoplegia with ipsilateral exotropia associated with infarct of the paramedian pontine tegmentum, including the medial longitudinal fasciculus (MLF).

Design/Methods NA

Results A diabetic and hypertensive 58-year-old female presented with a sudden 3-month history of acute onset of vertigo, horizontal diplopia, facial weakness, hemiparesis and gait instability. The clinical exam showed a left moderate facial paresis, right-sided hemiparesis and brachiocrural spasticity, hyperreflexia, Babinski sign and superficial and nociceptive hypoesthesia. Neuro-ophthalmological evaluation displayed skew deviation with left hypertropia and incomplete exotropia in primary position. In the left eye, adduction was limited with slow, hypometric, and paretic saccades; abducting saccades were also hypometric. In the right eye, the abducting saccades were hypermetric. Horizontal pursuit was normal. Rightwards, a dissociated nystagmus was present in the right eye. Vertical eye movements were misaligned due to the left hypertropia with saccadic smooth pursuit in both directions. The horizontal head impulse was normal. This integrates a left WEMINO and a left MG. The brain MRI showed an ischemic wedge-shaped lesion compatible with chronic left parasagittal (paramedian) pontine infarct extended from the facial colliculus to the ventral pons and the medial lemniscus, the corticospinal and corticobulbar tracts and the fasciculus of the facial nerve.

Conclusions

WEMINO and MGS syndromes are rare isolated clinical entities. This concomitance is possible, and the clinician must be aware.

Authors/Disclosures
Ricardo M. Ceballos-Lizarraga, MD (The Vestibular Project) PRESENTER	No disclosure on file
Carlos Palomino-Diaz	No disclosure on file
	No disclosure on file

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Abstract Details