WALL-EYED MONOCULAR INTER-NUCLEAR OPHTHALMOPLEGIA (WEMINO) SYNDROME, A RARE DECISIVE MANIFESTATION OF AN ISOLATED UNILATERAL PONTINE STROKE
Abstract
Isolated unilateral pontine infarction is an uncommon occurrence. It may bring a complex neuro-ophthalmic manifestation to the clinicians, making the on-spot-diagnosis a hard challenge. Wall-eyed monocular inter-nuclear ophthalmoplegia (WEMINO) syndrome is a rare variant of inter-nuclear ophthalmoplegia which also includes ipsilesional exotropia. The literature seems deficient in documenting WEMINO syndrome the primary presentation of isolated unilateral pontine stroke. The location of the causative lesion of WEMINO syndrome is a hot topic. Here, we discuss a case of WEMINO syndrome, a rare presentation of limited unilateral pontine stroke and its responsible lesion. To the best of our knowledge this is the first reported case from Pakistan. A short literature review has also been presented on the anatomy, pathophysiology and various manifestations of isolated unilateral pontine lesion in the region of medial longitudinal fascicules (MLF). Hence, this article enhances the understanding of clinicians regarding the responsible lesions limited to pons and its various manifestations, in order to enable clinicians to pick them in the early opportunity.
References
Haider AS. Unilateral internuclear ophthalmoplegia, strabismus and transient torsional nystagmus in focal pontine infarction. BMJ Case Rep 2016;2016:bcr2016216503.
Ceballos-Lizarraga R, Palomino-DÃaz C, Romero-Figueroa J. 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. Case Rep Neurol 2019;11(2):230-7.
Ikeda Y, Okamoto K. Lesion responsible for WEMINO syndrome confirmed by magnetic resonance imaging. J Neurol Neurosurg Psychiatry 2002;73(2):204-5.
Jeon SB, Chung SJ, Ahn H, Lee JH, Jung JM, Lee MC. Wall-Eyed Monocular Internuclear Ophthalmoplegia (WEMINO) with Contraversive Ocular Tilt Reaction. J Clin Neurol 2005;1(1):101-3.
Srivastava AK, Tripathi M, Gaikwad SB, Padma MV, Jain S. Internuclear ophthalmoplegia and torsional nystagmus: an MRI correlate. Neurol India 2003;51(2):271-2.
Bae YJ, Kim JH, Choi BS, Jung C, Kim E. Brainstem pathways for horizontal eye movement: pathologic correlation with MR imaging. Radiographics 2013;33(1):47-59.
Atkinson WJ. Arterial supply of the tegmentum and hypothalamus and its relation to vascular lesions of the brain-stem and autonomic disturbances. Ann R Coll Surg Engl 1950;7(1):38-66.
Schmahmann JD, Ko R, MacMore J. The human basis pontis: motor syndromes and topographic organization. Brain 2004;127(Pt 6):1269-91.
Johkura K, Kudo Y, Amano Y, Kikyo H, Imazeki R, Amari K, et al. Gaze palsy and exotropia in internuclear ophthalmoplegia. J Neurol Sci 2015;353(1-2):158-60.
Bogousslavsky J, Regli F. [Paralytic and non-paralytic pontine exotropia]. Rev Neurol (Paris) 1983;139(3):219-23.
Zhao ZN, Li XL, Ma GT, Zhu MJ. Unilateral internuclear ophthalmoplegia with upbeat nystagmus from ischemic origin: evidence for the paramedian tract neurons as a vertical neural integrator? Int J Clin Exp Med 2015;8(8):14257-9.
Kochar PS, Kumar Y, Sharma P, Kumar V, Gupta N, Goyal P. Isolated medial longitudinal fasciculus syndrome: Review of imaging, anatomy, pathophysiology and differential diagnosis. Neuroradiol J 2018;31(1):95-9.
Almutlaq A, Richard A. Eight-and-a-half syndrome: one-and-a-half syndrome with peripheral facial nerve palsy. CMAJ 2018;190(16):E510.
Downloads
Published
How to Cite
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
