Alternating hypertropias - bilateral 4th nerve palsies and alternating skew deviation

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Identifier Alternating_Hypertropias
Title Alternating hypertropias - bilateral 4th nerve palsies and alternating skew deviation
Subject Skew Deviation; Alignment; Fourth nerve palsy; Cerebellar pathology; Jerk nystagmus; Downbeat nystagmus; Gaze evoked nystagmus
Creator Daniel R. Gold, DO, Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, The Johns Hopkins School of Medicine
Description Seen here are two patients with alternating hypertropias. The first is a 70-year-old woman with a diagnosis of cerebellar ataxia, neuropathy, vestibular areflexia syndrome (CANVAS). In the video, both spontaneous downbeat nystagmus (DBN) and gaze-evoked nystagmus (GEN) are apparent, in addition to a right hypertropia in right gaze and a left hypertropia in left gaze, also referred to as an alternating skew deviation or an abducting hypertropia. The combination of these three findings (DBN, GEN, alternating skew) is highly suggestive of cerebellar flocculus/paraflocculus disease.1 ; The second patient is a 40-year-old woman who also has an alternating hypertropia, although in her case this is an adducting hypertropia due to bilateral 4th nerve palsies. In her case, there is a right hypertropia in left gaze and a left hypertropia in right gaze.
References 1.; Zee DS. Considerations on the mechanisms of alternating skew deviation in patients with cerebellar lesions. J Vestib Res 1996;6:395-401.
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Date 2018
Format video/mp4
Rights Management Copyright 2018. For further information regarding the rights to this collection, please visit:
Collection Neuro-ophthalmology Virtual Education Library: NOVEL
File Name Alternating_Hypertropias.mp4
Language eng
ARK ark:/87278/s6d83n91
Setname ehsl_novel_gold
Date Created 2018-11-26
Date Modified 2019-02-21
ID 1383125
Reference URL
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