Wall-Eyed Bilateral Internuclear Ophthalmoplegia: A Rare Complication of Cardiac Catheterization

Abstract

A 40-year-old woman was monitored for mitral, aortic, and tricuspid valve insufficiency caused by rheumatic heart disease and underwent right and left ventricular catheterization and coronary angiography. During the procedure, she suddenly complained of horizontal diplopia. Neuro-ophthalmologic examination revealed 40-prism diopter exotropia in the primary position and adduction paralysis in both eyes. Cranial magnetic resonance imaging revealed an infarct in the brainstem at the pontomesencephalic level in the medial longitudinal fasciculus site. The patient was diagnosed as having wall-eyed bilateral internuclear ophthalmoplegia (WEBINO). To the authors’ knowledge, this is the first report of a patient in whom WEBINO developed after cardiac catheterization.

KEYWORDS:

• Cardiac catheterization
• medial longitidunal fasciculus
• WEBINO