Daniel R. Gold, DO, Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, Emergency Medicine, and Medicine, The Johns Hopkins School of Medicine
30-yo-woman with MS presenting with acute vertigo and vertical diplopia. Examination demonstrated several aspects of the Wallenberg syndrome (her acute demyelinating lesion was in the left lateral medulla): ipsilesional (left) ocular lateropulsion (hypermetric saccades to the left, hypo to the right, not seen in the video), ipsilesional (left) hypotropia from skew deviation, and subtle right-beating nystagmus (not seen in the video). There was also a + head impulse test, which is typically a "peripheral" sign, although her + result was due to left vestibular nucleus involvement. A negative HIT is highly suggestive of a central localization in the acute vestibular syndrome whereas a + HIT can result from either peripheral or central localizations.
Spencer S. Eccles Health Sciences Library, University of Utah