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1 Bilateral pseudo-abducens palsies due to midbrain strokeThis 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 palsy on the right (i.e., responsible for his mydriatic pupil, absent supra- and...Image/MovingImage
2 Superior Oblique Myokymia (SOM)This is a patient with transient monocular oscillopsia OD and vertical diplopia noted to have many episodes of SOM in the office. There was not only myokymia OD, but also a 4 prism diopter left hypertropia during episodes (suggestive of mild depression OD from SO activation). Ocular motor and alignm...Image/MovingImage
3 Posterior Canal - BPPV: Epley and Semont maneuversEpley/canalith repositioning maneuver (CRP) To treat right posterior canal (PC)-BPPV (each position maintained for at least 30 seconds or until nystagmus and/or vertigo cease): • First the patient is placed in the long-sitting position • The head is rotated 45 degrees to the right • Then the p...Image/MovingImage
4 Horizontal Canal - BPPV: Gufoni for right apogeotropicTo treat the right apogeotropic (beating towards the sky with right ear down and with left ear down - e.g., left beating nystagmus with right supine roll test or with right ear down; right beating nystagmus with left supine roll test or with left ear down) horizontal canal (HC) variant: • The pati...Image/MovingImage
5 Horizontal Canal - BPPV: BBQ Roll to treat the right sideTo treat right horizontal canal (HC)-BPPV (each position maintained for at least 30 seconds or until nystagmus and/or vertigo cease): • First the patient is placed in the long-sitting position • Then in a supine position with the head elevated 30 degrees • Then the patient's head (or whole bod...Image/MovingImage
6 Anterior Canal - BPPV: Deep Head HangingRegardless or whether it is thought that the patient has right or left anterior canal (AC) involvement, the deep head hanging maneuver is performed in the same way. • First the patient is placed in the long-sitting position • Then the patient is moved into a supine position with the head in at l...Image/MovingImage
7 Leukemic leptomeningeal carcinomatosis causing 4th and 6th nerve palsiesThis is a 55-yo-man with CML that recurred as AML. Diagonal diplopia developed, and on examination he was found to have a partial right 6th nerve palsy, in addition to a left hypertropia that increased in right gaze, down gaze, and in left head tilt consistent with a left 4th nerve palsy. There was ...Image/MovingImage
8 Divergence insufficiency in cerebellar ataxiaThis is a 65-yo woman with complaints of imbalance (progressive over years) and horizontal diplopia at distance. On her exam, there was a small symptomatic esotropia at distance, but only a small esophoria at near. There were no obvious abduction deficits, and the 6 prism diopter ET at distance was...Image/MovingImage
9 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
10 Nystagmus due to paraneoplastic (anti-Yo) brainstem and cerebellar degenerationThis is a 40-yo-woman with anti-Yo antibody associated with ovarian cancer. Initial symptoms 2.5 years prior (to this video) included imbalance and dysarthria. She complained of oscillopsia which was due to her upbeat nystagmus (presumably the result of brainstem involvement), and diplopia (she had ...Image/MovingImage
11 Opsoclonus provoked by convergenceThis is a 40-yo-man with post-infectious opsoclonus-myoclonus syndrome. Opsoclonus was intermittently evident in primary position, but was consistently provoked (and intensified) by convergence. Occasionally, opsoclonus (back-to-back saccades in horizontal, vertical, torsional planes without an inte...Image/MovingImage
12 Pendular nystagmus and vision lossThree patients are presented here, each with poor vision (counting fingers or worse) related to retinitis pigmentosa in one patient (Usher's syndrome) and optic neuropathy in two patients, each of whom developed pendular nystagmus after vision loss developed. Visually mediated movements normally pre...Image/MovingImage
13 Congenital nystagmusPresented 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, suppression with convergence, strabismus and a latent component (common but not always...Image/MovingImage
14 Monocular horizontal pendular nystagmus in MSBoth of these patients have MS and monocular (OS) horizontal pendular nystagmus. The first patient seen in the video has normal afferent function and no evidence of optic nerve disease in either eye, while the second patient has severe OS>>OD optic nerve disease related to bouts of optic neuritis (t...Image/MovingImage
15 Post-infectious ocular flutter and myoclonus syndromeThis is a 35-yo-woman presenting with oscillopsia following a viral illness. She described being easily startled, with "shakiness" of the head/neck and body. She had myoclonus and ocular flutter, with the latter evident when she initiated saccades. Eye movement recordings showed that most of her sac...Image/MovingImage
16 Periodic alternating nystagmus and perverted head-shaking nystagmus in cerebellar degenerationThis is a 60-yo-woman with several years of worsening imbalance, diplopia (hers was actually unrelated to cerebellar pathology [although she did have an esotropia greater at distance that was cerebellar in origin] and due to thyroid eye disease) and blurry vision (due to her spontaneous nystagmus). ...Image/MovingImage
17 Voluntary Ocular FlutterThis is a 45-yo-man with intermittent complaints of horizontal oscillopsia for 1 year. On examination, all classes of eye movements were normal, and neurologic examination was normal. MRI of the brain had been performed previously and was normal. During the exam while viewing any target close to his...Image/MovingImage
18 Vertical gaze palsy and saccadic intrusions due to anti-Ri from head and neck carcinomaA 55-yo- woman was admitted for imbalance and double vision. Three weeks prior to presentation she first noticed swelling on the right side of her face and neck. CT of the head and neck showed right-sided cervical adenopathy and enlarged left retropharyngeal node. Ultrasound- guided biopsy of the n...Image/MovingImage
19 Eyelid retraction, pseudoabducens and upgaze palsy due to a mesodiencephalic hemorrhageThis is a 70-yo-man who suffered a right midline thalamic/rostral midbrain hemorrhagic stroke causing a pretectal (Parinaud's) syndrome. There was prominent eyelid retraction (Collier's sign), a left pseudo-abducens, and upgaze palsy with convergence retraction nystagmus. There was no light-near dis...Image/MovingImage
20 Demonstration of HINTS examination in a normal subjectIn 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
21 Oscillopsia and bilateral vestibular loss with gentamicin ototoxicityPatients with bilateral vestibular loss commonly experience oscillopsia with head movements, or an inability to stabilize retinal images with subsequent bouncing or jumping of the environment due to loss of vestibular function. This causes significant blurring of vision and disorientation, dizziness...Image/MovingImage
22 Superior Canal DehiscenceThis is a 60-yo-man who complained of autophony (eg, hearing his own heartbeat, noting that his own voice sounded too loud) and dizziness triggered with loud noises and straining at times. With pinched-nose Valsalva maneuver, there was downbeat-torsional (towards the right ear) nystagmus, suggestive...Image/MovingImage
23 Upbeat and downbeat nystagmus due to anti-VGCC antibodiesSeen here are two patients who presented with imbalance and vertical oscillopsia, the first with upbeat nystagmus, and the second with downbeat nystagmus. Both patients were found to have voltage-gated calcium channel antibodies in serum without evidence of systemic malignancy. The UBN patient had m...Image/MovingImage
24 Vibration and hyperventilation-induced nystagmus from vestibular schwannomaThis is a 50-yo-woman with imbalance, and with fixation removed on her examination (with Frenzel goggles), there was no spontaneous nystagmus. Using a handheld vibrator to vibrate the mastoids and vertex, there was a rightward slow phase and corrective leftward fast phase (left-beating nystagmus). V...Image/MovingImage
25 Prolonged lid twitch in myasthenia gravisThis 50-yo-woman with ocular MG demonstrated a spontaneous and particularly prolonged eyelid twitch.Image/MovingImage
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