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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+ 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... | Image/MovingImage |
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Abnormal Visually-Enhanced VOR in Cerebellar Ataxia, Neuropathy, Vestibular Areflexia Syndrome (CANVAS) | A 67 year old woman presented with 1 year of progressive numbness, gait instability, and oscillopsia when walking or with head movements. Examination showed excessive square-wave jerks, bilateral horizontal gaze-evoked nystagmus, impairment of the visually-enhanced vestibular ocular reflex (vVOR - s... | Image/MovingImage |
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The Acute Vestibular Syndrome with Dysarthria, Dysphagia, Dysphonia, Hemi-ataxia, and Saccadic Dysmetria Due to the Lateral Medullary (Wallenberg) Syndrome | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 50-year-old woman with the acute onset of vertigo, dysarthria, dysphagia and dysphonia/hoarseness (nucleus ambiguus), ptosis and imbalance. Her examination localized to a left lateral medullary (Wallenberg) synd... | Image/MovingImage |
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Acute Vestibular Syndrome with Ocular Tilt Reaction Due to Bacterial Labyrinthitis | This is a patient who initially presented with the acute vestibular syndrome (AVS, e.g., acute prolonged vertigo, spontaneous nystagmus) and right sided hearing loss, and was diagnosed with bacterial labyrinthritis. Her HINTS (Head Impulse, Nystagmus, Test of Skew) testing indicated a central etiolo... | Image/MovingImage |
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Acute Vestibular Syndrome With Skew Deviation and Positive Head Impulse Test Due to a Demyelinating Lesion | This is a patient who initially presented with the acute vestibular syndrome (AVS, e.g., acute prolonged vertigo, spontaneous nystagmus). ; See https://collections.lib.utah.edu/details?id=187730 for additional history. ; Her HINTS (Head Impulse, Nystagmus, Test of Skew) testing indicated a central e... | Image/MovingImage |
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The Acute Vestibular Syndrome with Skew Deviation, Gaze-evoked Nystagmus, and Bilaterally Abnormal Head Impulse Testing Due to AICA Stroke | This is a 60-year-old man with the acute onset of prolonged vertigo and nystagmus, consistent with the acute vestibular syndrome (AVS). HINTS (Head Impulse, Nystagmus, Test of Skew) exam demonstrated a central pattern: 1) Head impulse test (HIT) was abnormal to the right and to the left. An abnormal... | Image/MovingImage |
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Anterior Canal BPPV | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: Although the anterior canal (AC) variant of benign paroxysmal positional vertigo (BPPV) is rare, mainly owing to its orientation relative to gravity (which makes otoconial debris much less likely to enter it), it can occu... | Image/MovingImage |
| 8 |
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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... | Image/MovingImage |
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The Apogeotropic Variant of Horizontal Canal BPPV | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a patient with the apogeotropic (nystagmus beating towards the sky) variant of right horizontal canal (HC) benign paroxysmal positional vertigo (BPPV). In a patient with geotropic (nystagmus beating towards the gr... | Image/MovingImage |
| 10 |
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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... | Image/MovingImage |
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Bilateral 6th Nerve Palsies Due to Idiopathic Intracranial Hypertension | This is a 25-year-old woman who presented with diplopia and blurry vision. On exam, she was found to have papilledema and bilateral 6th nerve palsies. Her opening pressure was >40 cm of water with a normal CSF analysis, and neuroimaging was unremarkable aside from subtle findings that have been asso... | Image/MovingImage |
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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 ... | Image/MovingImage |
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Bruns Nystagmus Due to a Cerebellopontine Angle Tumor | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 15-yo-girl who experienced headache and imbalance leading to an MRI which showed a left sided cerebellopontine angle (CPA) tumor. Because of involvement of the left brainstem/cerebellum (e.g., dysfunction of the... | Image/MovingImage |
| 14 |
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Central Acute Vestibular Syndrome Due to Posterior Fossa Hemorrhage | This is a patient presenting with the acute vestibular syndrome (AVS, e.g., acute prolonged vertigo, spontaneous nystagmus) whose HINTS (Head Impulse, Nystagmus, Test of Skew) testing indicated a central etiology based on negative (normal) head impulse testing (HIT). Nystagmus was unidirectional and... | Image/MovingImage |
| 15 |
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Cerebellar Ataxia, Neuropathy, & Vestibular Areflexia Syndrome (CANVAS): Impaired Visually-Enhanced VOR and Abnormal Head Impulse Testing | A 67 year old woman presented with 1 year of progressive numbness, gait instability, and oscillopsia when walking or with head movements. Examination showed excessive square-wave jerks, bilateral horizontal gaze-evoked nystagmus, impairment of the visually-enhanced vestibular ocular reflex (vVOR - s... | Image/MovingImage |
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Chiari Malformation Causing Downbeat Nystagmus in Lateral Gaze | This is a 20-yo-man who presented with oscillopsia in lateral gaze from downbeat nystagmus (DBN). In primary gaze, very subtle DBN was only noted with ophthalmoscopy, but in lateral gaze, prominent DBN was present. Other central ocular motor signs included gaze-evoked nystagmus (GEN) vertically, in ... | Image/MovingImage |
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Chronic Progressive External Ophthalmoplegia (CPEO) and Cerebellar Signs | This is a 60-yo-woman who initially presented with imbalance and ophthalmoparesis. Initially, there was mild horizontal gaze limitation with mild gaze-evoked nystagmus and slow saccades, and over the years, gait ataxia and dysarthria (mainly a scanning quality to her speech) developed, and her ophth... | Image/MovingImage |
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Congenital Nystagmus | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: Presented here are two patients with congenital nystagmus demonstrating characteristic features including: mixed pendular and jerk nystagmus (usually gaze-evoked) waveforms, stays horizontal even in vertical gaze, suppres... | Image/MovingImage |
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Convergence Insufficiency and Square Wave Jerks in PSP | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 70-yo-woman with progressive supranuclear palsy with complaints of difficulty reading. Her husband noticed that she would frequently close one eye when attempting to read, and words were not clear on the page, a... | Image/MovingImage |
| 20 |
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Demonstration of HINTS Examination in a Normal Subject | In the acute vestibular syndrome - consisting of acute prolonged vertigo, spontaneous nystagmus, imbalance, nausea/vomiting, head motion intolerance which is typically due to vestibular neuritis or posterior fossa stroke - a 3 step test of ocular motor and vestibular function known as HINTS, has hig... | Image/MovingImage |
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Dix-Hallpike Maneuver in Posterior BPPV with Reversal of Nystagmus on Sitting Up | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a patient with typical posterior canal (PC) benign paroxysmal positional vertigo (BPPV), which is provoked by the Dix-Hallpike maneuver. When the patient is moved into the right Dix-Hallpike maneuver, after a brie... | Image/MovingImage |
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The Episodic Vestibular Syndrome | This is a 55-year-old man with 6 months of episodic vertigo without clear triggers/provocative factors, with each of his 3 previous episodes lasting less than 5 minutes. While in the clinic, he had one of his typical vertigo attacks. There was initially 30 seconds of right-beating-torsional nystagmu... | Image/MovingImage |
| 23 |
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Examples of Patients with Saccadic Intrusions (Square Wave Jerks) | Seen here are patients with saccadic intrusions that do have an intersaccadic interval. Square wave jerks are commonly seen in degenerative conditions, mainly involving the posterior fossa (e.g., cerebellar degeneration) and basal ganglia (e.g., progressive supranuclear palsy). | Image/MovingImage |
| 24 |
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Eye Closure and Oculopalatal Tremor | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This patient suffered a traumatic brain injury with brainstem injury resulting in damage to Mollaret's triangle and palatal tremor. Inferior olivary hypertrophy was noted on her MRI, although no vertical and/or torsional ... | Image/MovingImage |
| 25 |
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The Geotropic Variant of Horizontal Canal BPPV | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a patient with the geotropic (nystagmus beating towards the ground) variant of left horizontal canal (HC) benign paroxysmal positional vertigo (BPPV). In a patient with geotropic (nystagmus beating towards the gro... | Image/MovingImage |