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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.48 no.4 São Paulo Dec. 1990

http://dx.doi.org/10.1590/S0004-282X1990000400016 

Wall-eyed bilateral internuclear ophthalmoplegia (webino syndrome) and myelopathy in pyoderma gangrenosum

 

Oftalmoplegia internuclear bilateral e exotropia (síndrome de Webino) e mielopatia no pyoderma gangrenosum

 

 

Marco Aurélio LanaI; Paulo Roberto R. MoreiraII; Leonardo B. NevesIII

IAssociated Professor of Neurology - Federal University of Minas Gerais Medical School (UFMG)
IINeurologist - Federal University of Minas Gerais Medical School (UFMG)
IIIDermatologist - Federal University of Minas Gerais Medical School (UFMG)

 

 


SUMMARY

A 35-year-old female with pyoderma gangrenosum developed paraparesis with a sensory level at L1. Three months later she complained of diplopia and was found to have bilateral internuclear ophthalmoplegia with exotropia and no ocular convergence. The term Webino syndrome has been coined to design this set of neuro-opthalmologic findings. Although it was initially attributed to lesions affecting the medial longitudinal fasciculus and the medial rectus subnuclei of the oculomotor complex in the midbrain the exact location of the lesion is still disputed. In the present case both myelopathy and Webino syndrome were probably due to vascular occlusive disease resulting from central nervous system vasculitis occurring in concomitance to pyoderma gangrenosum.


RESUMO

O termo Webino é formado pelas iniciais dos componentes da síndrome (walleyed bilateral internuclear ophthalmoplegia), havendo também perda da convergência ocular. Relatamos o caso de uma paciente de 35 anos de idade, com pioderma gangrenosum, que desenvolveu subitamente mielopatia com nível sensitivo em L1 e, três meses depois, quadro súbito de oftalmoplegia internuclear bilateral, exotropia e perda de convergência. Há poucos casos de síndrome de Webino relatados na literatura, a maioria deles secundária a esclerose múltipla e a doença vascular cerebral. A localização da lesão responsável pela síndrome ainda não está bem estabelecida mas, acredita-se que os fascículos longitudinais mediais e os subnúcleos dos retos mediais do complexo oculomotor no mesencéfalo sejam afetados, embora não haja ainda confirmação anátomo-patológica. O pioderma gangrenosum é condição caracterizada por úlceras de crescimento rápido e de bordas elevadas com halo eritematoso localizadas preferencialmente na cabeça, tronco e membros inferiores. Embora sua natureza ainda seja desconhecida, parece ser secundário a vasculite subjacente, estando associado a grande variedade de doenças sistêmicas. No caso presente, a ocorrência da síndrome de Webino e de mielopatia sugere aue as lesões no sistema nervoso sejam de natureza vascular, provavelmente secundárias a vasculite. Este é o primeiro relato da literatura de complicações neurológicas do pioderma gangrenosum e da associação de mielopatia à síndrome. de Webino.


 

 

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Dr. Marco Aurélio Lana - Departamento de Neurologia, Faculdade de Medicina da UFMG -Av. Alfredo Balena 190 - 30130 Belo Horizonte MO - Brasil.

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