A Case of Wernekink Commissure Syndrome

This is a case of a lady who presented with slurring of speech and swaying while walking for 3 days.She is a known case of Diabetes Mellitus, Hypertension and dyslipidemia and is on treatment for it.Examination showed left side Internuclear ophthalmoplegia and bilateral cerebellar ataxia.MRI showed FLAIR hyperintensity in tegmentum of left caudal midbrain showing diffusion restriction.The patient was diagnosed with Wernekink commissure syndrome based on the clinical features and MRI findings.The patient was started on antiplatelets along with other treatment.The point of interest in this case is it is an extremely rare disease with only few case reports reported and its presentation with bilateral cerebellar symptoms makes it extremely difficult to localize the lesion .Unilateral INO in some cases may help to narrow down the differentials.