{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T05:40:17Z","timestamp":1756359617376,"version":"3.44.0"},"reference-count":22,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,9,2]]},"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:p>A 48-year-old woman presented with sudden-onset altered sensorium 2\u2009days after a snake bite (unidentified species) and was found to have a large right frontal intracerebral haemorrhage (ICH) with transtentorial herniation (TTH) causing brain stem compression. A day later, neurological examination revealed internuclear ophthalmoplegia (INO) fitting the clinical description of wall eyed bilateral INO syndrome. INO is a rare ocular motor sign, the most common causes being brain stem infarction, haemorrhage or demyelinating disease. It rarely acts as a false localising sign, such as in this case, and in an even rarer cause for ICH, that is, haemotoxic snake bite without initial evidence of coagulopathy. An emphasis needs to be laid on detailed physical examination, often considered a lost art nowadays, to help detect subtle clinical signs which could herald ominous complications of conditions like TTH and help in early diagnosis and treatment of the same.<\/jats:p>","DOI":"10.1136\/bcr-2021-244830","type":"journal-article","created":{"date-parts":[[2021,9,14]],"date-time":"2021-09-14T12:55:34Z","timestamp":1631624134000},"page":"e244830","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Wall eyed bilateral internuclear ophthalmoplegia (WEBINO) syndrome as a false localising sign in intracranial haemorrhage due to snake bite"],"prefix":"10.1136","volume":"14","author":[{"given":"Shruti","family":"Sinha","sequence":"first","affiliation":[{"name":"Internal Medicine, Mahatma Gandhi Mission's Medical College Kamothe, Navi Mumbai, Maharashtra, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bhaimangesh Bhanudas","family":"Naik","sequence":"additional","affiliation":[{"name":"Internal Medicine, Mahatma Gandhi Mission's Medical College Kamothe, Navi Mumbai, Maharashtra, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaishree","family":"Ghanekar","sequence":"additional","affiliation":[{"name":"Internal Medicine, Mahatma Gandhi Mission's Medical College Kamothe, Navi Mumbai, Maharashtra, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,9,14]]},"reference":[{"key":"2025082722134838000_14.9.e244830.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200105103441907"},{"key":"2025082722134838000_14.9.e244830.2","first-page":"PD03-PD04","article-title":"Spontaneous intracerebral bleed post snake envenomation","volume":"11","author":"Menon","year":"2017","journal-title":"J Clin Diagn Res"},{"key":"2025082722134838000_14.9.e244830.3","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/S0377-1237(17)30543-9","article-title":"Experience with VIPERINE envenomation","volume":"54","author":"Kalra","year":"1998","journal-title":"Med J Armed Forces India"},{"key":"2025082722134838000_14.9.e244830.4","doi-asserted-by":"publisher","DOI":"10.1016\/0041-0101(69)90154-8"},{"key":"2025082722134838000_14.9.e244830.5","doi-asserted-by":"publisher","DOI":"10.3109\/01658108509014426"},{"key":"2025082722134838000_14.9.e244830.6","doi-asserted-by":"crossref","unstructured":"Hoyt WF , Daroff RB . 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