A 62-year-old man developed binocular diplopia during hospitalization for an upper-gastrointestinal
bleed 1 month after clipping of a superior cerebellar artery aneurysm. Gradient echo
showed punctate microhemorrhage at the level of left inferior colliculus (Fig. 1). Motility examination revealed primary gaze left hypertropia (presumed skew deviation)
with bilateral exotropia, adduction deficits, and dissociated horizontal abducting
nystagmus and downbeat component with intact convergence, consistent with an exotropic
bilateral internuclear ophthalmoplegia (EBINO; see Video). Although described in the
literature as the “wall-eyed BINO (WEBINO), we prefer the less pejorative description
of EBINO. The patient recovered with mild residual diplopia following a left modified
Harada-Ito procedure. EBINO is most commonly caused by brainstem infarctions and demyelinating
lesions, but EBINO resulting from an superior cerebellar artery aneurysm has not been
previously reported.
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Article Info
Publication History
Published online: October 17, 2020
Accepted:
September 17,
2020
Received in revised form:
September 5,
2020
Received:
August 25,
2020
Identification
Copyright
© 2020 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
