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
Alternative Title Video 4.32 Alternating hypertropias in two patient due to bilateral 4th nerve palsies and alternating skew deviation from Neuro-Ophthalmology and Neuro-Otology Textbook
Creator Daniel R. Gold, DO
Affiliation (DRG) Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, Emergency Medicine, and Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland
Subject Skew Deviation; Alignment; Fourth Nerve Palsy; Cerebellar Pathology; Jerk Nystagmus; Downbeat Nystagmus; Gaze Evoked Nystagmus
Description 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 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. 𝗡𝗲𝘂𝗿𝗼-𝗼𝗽𝗵𝘁𝗵𝗮𝗹𝗺𝗼𝗹𝗼𝗴𝘆 𝗮𝗻𝗱 𝗡𝗲𝘂𝗿𝗼-𝗼𝘁𝗼𝗹𝗼𝗴𝘆 𝗧𝗲𝘅𝘁𝗯𝗼𝗼𝗸 𝗟𝗲𝗴𝗲𝗻𝗱: 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. 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. https://collections.lib. utah.edu/ark:/87278/s6d83n91
Date 2018
References 1.; Zee DS. Considerations on the mechanisms of alternating skew deviation in patients with cerebellar lesions. J Vestib Res 1996;6:395-401.
Language eng
Format video/mp4
Type Image/MovingImage
Collection Neuro-Ophthalmology Virtual Education Library: Dan Gold Neuro-Ophthalmology Collection: https://novel.utah.edu/Gold/
Publisher North American Neuro-Ophthalmology Society
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E SLC, UT 84112-5890
Rights Management Copyright 2016. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright
ARK ark:/87278/s6d83n91
File Name Alternating_Hypertropias.mp4
Setname ehsl_novel_gold
ID 1383125
Reference URL https://collections.lib.utah.edu/ark:/87278/s6d83n91
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