A collection of videos relating to the diagnosis and treatment of eye movement disorders. This collection includes many demonstrations of examination techniques.
Dan Gold, D.O., Associate Professor of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, Emergency Medicine, and Medicine, The Johns Hopkins School of Medicine.
A collection of videos relating to the diagnosis and treatment of eye movement disorders.
NOVEL: https://novel.utah.edu/
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| Title | Description | Subject | ||
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+ HIT, + Skew, Unidirectional Nystagmus: Central Acute Vestibular Syndrome Due to Wallenberg Syndrome | This is a 45-year-old woman who presented to the ED with acute prolonged vertigo and vertical diplopia. She was seen as an outpatient 1 month after her ED visit, and double vision and balance were improving by that time. Her HINTS testing showed the following (seen in the video): 1) Head Impulse - A... | VOR HIT Abnormal; Abnormal Alignment; Skew; Jerk Nystagmus; Vestibular Nystagmus; Acute Vestibular Nystagmus |
| 2 |
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3rd Nerve Palsy With Preserved 4th Nerve Function | 80-yo-woman with a left vasculopathic 3rd nerve palsy (minimal pupil involvement of about 1 mm relative mydriasis OS - other etiologies ruled out and resolved as expected over months). Although the inferior rectus is paretic, intact superior oblique muscle function can be demonstrated by asking the ... | Third (Oculomotor) Nerve Palsy; Third subnuclear |
| 3 |
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6th Nerve Palsy as Initial Presentation of Metastatic Lung Cancer | A video describing 6th nerve palsy as initial presentation of metastatic lung cancer. | Sixth Nerve Palsy; Lung Cancer; Metastatic Cancer |
| 4 |
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Aberrant Regeneration of the 3rd Nerve | Aberrant regeneration in two patients: 1) a young woman with a right cavernous sinus meningioma with subsequent development of aberrant regeneration demonstrated by eyelid elevation OD in attempted downgaze (i.e., some fibers that were supposed to innervate the right IR were misrouted to the right l... | Third (Oculomotor) Nerve Palsy; Third Aberrant |
| 5 |
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Abnormal Active Head Impulse Testing Recorded Asynchronously in Bilateral Vestibular Loss | This is a video of patient with the subacute onset of head movement-dependent oscillopsia due to bilateral vestibular loss (with obvious bilaterally abnormal head impulse test (HIT) at the bedside), in addition to central ocular motor signs including saccadic smooth pursuit and gaze-evoked nystagmus... | Vestibulo-Ocular Reflex; Head Impulse Testing |
| 6 |
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Abnormal Head Impulse Test in Vestibular Neuritis 1 Week After Onset | This is a 25-year-old woman who experienced the acute vestibular syndrome due to right-sided vestibular neuritis 1 week prior to this video. Left-beating nystagmus (LBN) was only noted in left gaze, but with fixation-removed, there was clear LBN in primary position that increased with head-shaking a... | Abnormal VOR; Vestibulocochlear Nerve; Acute Vestibular Sydrome |
| 7 |
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Abnormal Visually-enhanced Vestibulo-ocular Reflex (vVOR) in Cerebellar Ataxia, Neuropathy, Vestibular Areflexia Syndrome (CANVAS) | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This patient complained of chronic (unexplained cough), progressive numbness in the legs and feet, gait instability, and oscillopsia when walking or with head movements. Examination showed excessive square-wave jerks, bil... | Visually-enhanced Vestibulo-ocular Reflex; Cerebellar Ataxia; Neuropathy; Vestibular Areflexia Syndrome |
| 8 |
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Acquired Elliptical Pendular Nystagmus Suppressed by Blinks and Saccades | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 70-year-old man who experienced the gradual onset of oscillopsia over weeks about 3 months prior to this video recording. Examination demonstrated elliptical pendular nystagmus which was atypical for infantile n... | Pendular Nystagmus |
| 9 |
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Acute Vestibular Neuritis With Unidirectional Nystagmus and Abnormal Video Head Impulse Test | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is 45-year-old man who presented to the emergency department (ED) 2 days prior to this video recording with acute onset prolonged vertigo, nausea, head motion intolerance, unsteadiness and spontaneous nystagmus, cons... | Jerk Nystagmus; Acute Vestibular Syndrome; Vestibular Nystagmus; Eighth Nerve; Abnormal VOR-HIT |
| 10 |
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The Acute Vestibular Syndrome in MS Due to Middle Cerebellar Peduncle/Root Entry Zone Lesion | This is a 13 year-old girl with relatively abrupt onset vertigo and oscillopsia. On exam, there was primarily right-beating nystagmus in primary gaze with a slight upward (upbeat) component, giving the nystagmus an oblique appearance. The upward component and lack of a clear torsional component acut... | Jerk Nystagmus; Vestibular Nystagmus; Vestibulo-ocular Reflex; Head Impulse Testing; Gaze-evoked Nystagmus |
| 11 |
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Alternating Hypertropias - Bilateral 4th Nerve Palsies and Alternating Skew Deviation | 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... | Skew Deviation; Alignment; Fourth Nerve Palsy; Cerebellar Pathology; Jerk Nystagmus; Downbeat Nystagmus; Gaze Evoked Nystagmus |
| 12 |
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Anti-GAD Associated Cerebellopathy and Bilateral Vestibulopathy | This is a 70-year-old woman with the subacute onset of severe imbalance and dizziness. On her initial examination, she had prominent gaze-evoked nystagmus and bilateral vestibular loss. Smooth pursuit was saccadic, although her vestibulo-ocular reflex (VOR) suppression was much smoother. Usually pur... | Abnormal Pursuit; Normal VORS; VOR Abnormal; HIT Abnormal; Jerk Nystagmus; Gaze Evoked Nystagmus |
| 13 |
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Apogeotropic and Downbeat Central Positional Nystagmus Provoked While Seated | This is a young man with intermittent complaints of positional vertigo. With Dix-Hallpike and roll testing, he had apogeotropic positional nystagmus (e.g., right beating nystagmus with the left ear down, and left beating nystagmus with the right ear down) in addition to strong downbeat nystagmus in... | |
| 14 |
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Apraclonidine Testing in Horner's syndrome | This patient experienced relatively abrupt ptosis and was seen and diagnosed with a Horner's syndrome within a few days of the onset. There were no other exam findings and history did not offer clues as to the etiology. Neuroimaging of the oculosympathetic tract was unrevealing. Apraclonidine testin... | Horner's Syndrome |
| 15 |
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Atypical Ocular Motor Features (Gaze-evoked Nystagmus) in PSP | This is a 70-yo-woman who met clinical and radiologic diagnostic criteria for progressive supranuclear palsy (PSP). Typical ocular motor features of PSP include square wave jerks, hypometric saccades, choppy pursuit/VORS, impaired down>upgaze (supranuclear in origin) and impaired down>upward saccade... | Abnormal Saccades; OMS Cerebellar; Jerk Nystagmus; Upbeat Nystagmus; Gaze Evoked Nystagmus |
| 16 |
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Bilateral Horizontal Gaze Palsy and Oculopalatal Tremor Due to Pontine Hemorrhage | This 70-yo-woman experienced headache and diplopia and was found to have a hemorrhage centrally within the dorsal pons. Months after the onset, the patient was seen in clinic and had no horizontal eye movements (pursuit, saccades, VOR) in either eye, suggestive of bilateral nuclear 6th nerve palsies... | VOR HIT Abnormal; Horizontal Gaze Palsy; OMS PONS; Pendular Nystagmus; Oculopalatal |
| 17 |
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Bilateral INOs and Partial 3rd Nerve Palsies | This is a 45-year-old man with progressive ptosis and ophthalmoparesis. 10 years prior to presentation, he experienced diplopia and had a hyperintense lesion involving the medial longitudinal fasciculus (MLF) per report. Over time, he developed bilateral adduction paresis, ptosis and upgaze paresis ... | Abnormal Range; Third Subnuclear; INO; Mesencephalon |
| 18 |
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Bilateral INOs Due to Stroke | This is a 65-year-old man with multiple vascular risk factors who experienced the abrupt onset of diplopia 6 months prior to this video. MRI done within 24 hours of onset was unremarkable. Examination demonstrated subtle bilateral adduction lag with horizontal saccades. There was very mild abducting... | Abnormal Saccades; Abnormal Range |
| 19 |
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Bilateral Pseudo-abducens Palsies Due to Midbrain Stroke | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a man who suffered right>left midbrain strokes due to endocarditis complaining of ptosis and inability to move his eyes as well as hallucinations (peduncular hallucinosis). There was a presumed nuclear 3rd nerve p... | Bilateral Pseudo-abducens Palsies; Midbrain Stroke |
| 20 |
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Bilateral Vestibular Loss With Gaze-Evoked Nystagmus and Saccadic Visually Enhanced VOR | This is 55-year-old man with the subacute onset of head movement-induced oscillopsia and dizziness. He had a history of psoriatic arthritis. He had not used medications known to be vestibulo-toxic such as gentamicin. ; Salient findings on his examination included 1) bilateral vestibular loss (BVL) d... | Jerk Nystagmus; Gaze-Evoked Nystagmus; Abnormal VOR-HIT; Eighth Nerve |
| 21 |
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Bilaterally Abnormal Head Impulse Test | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This video is an example of bilaterally abnormal head impulse test (HIT) due to bilateral vestibular loss (BVL). Typical symptoms in BVL: head movement-induced dizziness and jumping vision for years with visual jumping/b... | Abnormal VOR-HIT; Eighth Nerve |
| 22 |
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Cavernous Sinus Mass Causing Right 3rd and 4th Nerve Palsies | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: 25-yo-man who complained of diplopia and was initially found to have right 4th and 6th nerve palsies in the setting of a right cavernous sinus mass (subsequently diagnosed as Ewing's sarcoma). When seen in follow-up (this... | Third (Oculomotor) Nerve Palsy; ThirdSsubnuclear; Fourth (Trochlear) Nerve Palsy |
| 23 |
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Central (Nuclear) 3rd Nerve Palsies | Shown here are two patients with left sided midbrain pathology (hemorrhage and ischemia) which caused damage to the 3rd nucleus. Both of the patients have ipsilateral mydriasis, adduction, supra- and infraduction paresis. Ipsilateral>contralateral ptosis is also present, and localizes to the central... | Range of Eye Movements/Motility Abnormal; Third Nuclear; Upgaze Palsy; Downgaze Palsy; Mesencephalon; Jerk Nystagmus; Rotary Nystagmus |
| 24 |
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Central 4th Nerve Palsy with Contralateral Horner's Syndrome | This is a 60-yo-woman who presented with a complaint of diplopia. Examination demonstrated a left hypertropia that worsened in right and down gaze as well as in left head tilt, and a left 4th nerve palsy was diagnosed. There was also evidence of a mild motility deficit in down/medial gaze OS, consis... | Horner's; Fourth Nerve Palsy; Mesencephalon |
| 25 |
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Central Vestibular Nystagmus in Anti-DPPX Encephalitis | This is a young woman who presented with oscillopsia due to spontaneous nystagmus in addition to gastrointestinal symptoms which led to the diagnosis of anti-DPP axis encephalitis. She was treated with rituximab, and experience gradual improvement over time. However, years after the onset, she con... |