Wall-eyed bilateral internuclear ophthalmoplegia in central nervous systemcryptococcosis

Only one case of wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) has been described in central nervous system cryptococcosis. The disorder w as initially unilateral, then became bilateral with skew deviation and vert ical upgaze deficit. We report a case of WEBINO in central nervous system c ryptococcosis in a patient with acquired immune deficiency syndrome. Magnet ic resonance imaging revealed high signal on T2 images in the right midbrai n, left frontal vertex, left splenium, and cerebellum. With treatment, the internuclear ophthalmoplegia improved; however, the convergence insufficien cy remained. Disruption of input from cortical supranuclear locations or th e region of the rostral interstitial nucleus of the medial longitudinal fas ciculus has been proposed as a mechanism in the absence of convergence. Thi s correlates in our patient with the lesions seen on magnetic resonance ima ges.