Advertisement

Exotropic bilateral internuclear ophthalmoplegia following a superior cerebellar artery aneurysm clipping

  • Mark Daniel Bailey
    Affiliations
    Baylor College of Medicine, Houston, TX
    Search for articles by this author
  • Shruthi Harish Bindiganavile
    Affiliations
    Baylor College of Medicine, Houston, TX
    Search for articles by this author
  • Andrew G. Lee
    Correspondence
    Correspondence to Andrew G. Lee, MD, Blanton Eye Institute, Houston Methodist Hospital, 6560 Fannin Street Suite 450, Houston, TX 77030
    Affiliations
    Baylor College of Medicine, Houston, TX

    Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX

    Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX

    Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY

    Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX

    University of Texas MD Anderson Cancer Center, Houston, TX

    Texas A and M College of Medicine, Bryan, TX

    Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA
    Search for articles by this author
Published:October 17, 2020DOI:https://doi.org/10.1016/j.jcjo.2020.09.019
      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.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Canadian Journal of Ophthalmology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect