HINTS Exam and Saccadic Dysmetria in Lateral Medullary Stroke

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Identifier Central_HINTS_and_saccadic_dysmetria_in_lateral_medullary_stroke
Title HINTS Exam and Saccadic Dysmetria in Lateral Medullary Stroke
Subject Abnormal Saccades, Acute Vestibular Syndrome, Jerk Nystagmus, Vestibular Nystagmus, Normal VOR, Skew Deviation, OMS Medulla
Creator Daniel R. Gold, DO, Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, Emergency Medicine, and Medicine, The Johns Hopkins School of Medicine; Tzu-Pu Chang, MD, Department of Neurology/Neuro-Medical Scientific Center, Taichung Tzu Chi Hospital, Tzu Chi University', Buddhist Tzu Chi Medical Foundation, Taiwan
Description This is a 50-year-old who experienced the abrupt onset of prolonged vertigo following chiropractic therapy 2 months prior. Initial work-up included an MRI and MR angiogram - MR-diffusion weighted imaging showed an acute left lateral medullary stroke and left vertebral artery occlusion, which was thought to be related to a dissection. ; The examination seen here was performed 2 months following his stroke, and there was no spontaneous nystagmus with fixation. When fixation was removed with video infrared goggles, right-beating (with a slight torsional component, top poles beating towards the right ear) nystagmus was apparent. Head impulse testing in the planes of the horizontal canals was normal, which is a "central" sign in patients presenting with acute vertigo and spontaneous nystagmus. He also had a skew deviation with a left (ipsilesional) hypotropia. When the utricle-ocular motor fibers are affected caudal to their decussation as in a lateral medullary stroke, the hypotropic eye will be ipsilesional as in this case. Therefore, the HINTS (Head Impulse, Nystagmus, Test of Skew) exam was consistent with a central localization. ; Additionally, there was saccadic dysmetria, with hypermetric saccades to the (ipsilesional) left side and hypometric saccades to the (contralesional) right side. Although not shown here, there was also leftward ocular lateropulsion, a finding which is usually seen ipsilateral to hypermetric saccades. This is a typical finding in the Wallenberg syndrome, given involvement of the inferior cerebellar peduncle and the climbing fibers that course through it on their way to the ipsilateral dorsal vermis (see normal saccadic pathway https://collections.lib.utah.edu/details?id=1260093, and what happens to saccades with lateral medullary injury https://collections.lib.utah.edu/details?id=1260094).
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Date 2018-02
Type Image/MovingImage
Format video/mp4
Relation is Part of NOVEL: Neuro-ophthalmology Virtual Education Library Examination Collection
Rights Management Copyright 2018. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E, SLC, UT 84112-5890
Collection Neuro-ophthalmology Virtual Education Library: NOVEL http://NOVEL.utah.edu
Language eng
ARK ark:/87278/s6546m8r
Setname ehsl_novel_gold
Date Created 2018-02-07
Date Modified 2021-05-06
ID 1295174
Reference URL https://collections.lib.utah.edu/ark:/87278/s6546m8r
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