Early Diagnosis of WEBINO (Wall-Eyed Bilateral Internuclear Ophthalmoplegia) Syndrome Using Thin-Slice Gapless Diffusion-Weighted Imaging in an Acute Ischemic Stroke Patient: A Case Report

We report a case of acute ischemic stroke presenting as wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) syndrome. A 71-year-old woman experienced transient diplopia, followed by the sudden onset of binocular misalignment, gait instability, and nausea. Neurological examination demonstrated exotropia and bilateral adduction impairment, consistent with WEBINO syndrome. An initial routine brain MRI did not reveal significant findings. However, thin-slice, gapless diffusion-weighted imaging (DWI) detected a high signal in the dorsal midline of the pons, confirming the diagnosis of acute pontine infarction. The patient received antiplatelet therapy, leading to a gradual improvement in her symptoms. This case highlights the need to consider WEBINO syndrome in cases of sudden-onset exotropia. It underscores the value of thin-slice, gapless DWI in identifying small brainstem infarcts that may be missed by routine imaging. Early and accurate diagnosis is essential for effective management and prognosis in such cases.