Illustration of an eye with a pulse radiating outwards, set against a brain scan.

Unveiling the Mystery: What Wall-Eyed Internuclear Ophthalmoplegia Reveals About Your Brain

Nico Varela in Health & Wellness December 2025 • 4 min read.

"A deep dive into pulsatile proptosis and wall-eyed bilateral internuclear ophthalmoplegia: causes, symptoms, and the critical role of neuroimaging in diagnosis."

In the intricate world of neurology, certain conditions serve as windows into the complex workings of the brain. Pulsatile proptosis, characterized by a bulging of the eye that pulses with the heartbeat, and wall-eyed bilateral internuclear ophthalmoplegia (WEBINO), a condition where the eyes struggle to move in coordination, are two such conditions. While rare, their presence often points to underlying neurological issues that demand immediate attention.

A recent correction published in Neurology® highlighted the importance of accurate neuroimaging in diagnosing these conditions. The original Teaching Video NeuroImage article, "Pulsatile proptosis and wall-eyed bilateral internuclear ophthalmoplegia," had an error in the arrow placement within Figure 2, underscoring just how crucial precision is when interpreting brain scans.

This article will delve into the significance of pulsatile proptosis and WEBINO, shedding light on what these conditions reveal about the brain and emphasizing the critical role of neuroimaging in their diagnosis. Understanding these conditions is not just for medical professionals; it empowers everyone to recognize potential symptoms and seek timely medical advice.

Decoding Pulsatile Proptosis: What Causes the Bulging?

Illustration of an eye with a pulse radiating outwards, set against a brain scan.

Pulsatile proptosis, or the rhythmic bulging of the eye, isn't a standalone disease but rather a symptom indicative of an underlying issue. Its pulsating nature is directly linked to the pressure changes within the blood vessels surrounding the eye. Several factors can trigger this unusual presentation:

Vascular Abnormalities: Conditions like arteriovenous fistulas (AVFs), where there's an abnormal connection between an artery and a vein, can disrupt normal blood flow and pressure around the eye socket.

Orbital Tumors: While less common, tumors in the eye socket can sometimes cause pulsatile proptosis.
Inflammation and Infection: In rare cases, inflammation or infection within the orbit may lead to this symptom.

The key to diagnosing the cause of pulsatile proptosis lies in detailed neuroimaging, typically with CT scans or MRIs. These scans allow doctors to visualize the structures around the eye and identify any abnormalities that may be contributing to the pulsating effect.

The Road Ahead: Navigating Diagnosis and Treatment

Pulsatile proptosis and wall-eyed internuclear ophthalmoplegia may sound intimidating, but with accurate diagnosis and timely intervention, effective management is often possible. The journey begins with recognizing the symptoms and seeking prompt medical attention. Advanced neuroimaging techniques, combined with expert clinical evaluation, pave the way for identifying the root cause and tailoring a treatment plan to address the specific needs of each patient. Remember, staying informed and proactive about your health is the first step towards a brighter, healthier future.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

Everything You Need To Know

What exactly is Pulsatile Proptosis and what causes it?

Pulsatile proptosis is characterized by a bulging of the eye that pulses in rhythm with the heartbeat. This occurs due to pressure changes within the blood vessels around the eye. Several factors can lead to it. These include vascular abnormalities like arteriovenous fistulas (AVFs), orbital tumors, and, in rare cases, inflammation or infection within the eye socket (orbit). Precise neuroimaging, such as CT scans or MRIs, is critical to visualizing the eye's structures and determining the underlying cause.

What is Wall-Eyed Bilateral Internuclear Ophthalmoplegia (WEBINO) and what does it signify?

WEBINO is a condition where the eyes struggle to move in coordination. Though the article doesn't explicitly detail the exact causes of WEBINO, it emphasizes that its presence, along with pulsatile proptosis, often indicates underlying neurological issues that require immediate attention. The article focuses more on how neuroimaging helps diagnose it, not the direct causes.

How does neuroimaging help in diagnosing conditions like Pulsatile Proptosis and WEBINO?

Neuroimaging, specifically CT scans and MRIs, plays a critical role in diagnosing both pulsatile proptosis and WEBINO. These advanced techniques allow medical professionals to visualize the structures around the eye and within the brain. In the case of pulsatile proptosis, neuroimaging can reveal vascular abnormalities (like AVFs), tumors, or signs of inflammation that cause the pulsating bulge. In the broader context, accurate imaging helps pinpoint the underlying causes of these conditions, impacting diagnosis and treatment strategies.

Can you explain the connection between Pulsatile Proptosis and blood vessels?

The pulsating nature of pulsatile proptosis is directly linked to the pressure changes within the blood vessels surrounding the eye. Conditions like arteriovenous fistulas (AVFs), where there's an abnormal connection between an artery and a vein, disrupt normal blood flow and pressure. This disruption is what leads to the rhythmic bulging of the eye that pulses with the heartbeat. Neuroimaging helps to identify these vascular abnormalities.

Why is early diagnosis of Pulsatile Proptosis and WEBINO so important?

Early diagnosis of both pulsatile proptosis and WEBINO is crucial because these conditions often signal underlying neurological issues that need immediate attention. Timely intervention can lead to effective management and improved outcomes. Accurate diagnosis, facilitated by advanced neuroimaging, is the first step. Combining this with expert clinical evaluation allows for tailored treatment plans to address the specific needs of each patient, ultimately leading to a brighter and healthier future.