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1 "Pseudonystagmus" Due to Bilateral Vestibular Loss and Head TremorThis is a 65-yo-woman with complaints of imbalance, dizziness, and horizontal oscillopsia. On exam, she had a high frequency, low amplitude (mainly horizontal) head tremor, and with ophthalmoscopy, the optic nerve was clearly oscillating back and forth at the same frequency as her head tremor, which...Image/MovingImage
2 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
3 + HIT, + Skew, Unidirectional Nystagmus: Central Acute Vestibular Syndrome Due to Wallenberg SyndromeThis 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
4 Abnormal Active Head Impulse Testing Recorded Asynchronously in Bilateral Vestibular LossThis 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...Image/MovingImage
5 Abnormal Head Impulse Test in Vestibular Neuritis 1 Week After OnsetThis 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...Image/MovingImage
6 Anterior Canal BPPVAlthough 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 occur. Because of the relatively para-sagittal orientation of the AC (more so than ...Image/MovingImage
7 Acute Vestibular Neuritis With Unidirectional Nystagmus and Abnormal Video Head Impulse TestThis 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, consistent with the acute vestibular syndrome. Video-oculography examination in the...Image/MovingImage
8 Alternating Hypertropias - Bilateral 4th Nerve Palsies and Alternating Skew DeviationSeen 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...Image/MovingImage
9 Bilateral riMLF syndrome causing vertical saccadic palsy and loss of ipsitorsional fast phasesThis is a 60-year-old man who developed fatigue and diabetes insipidus about 12 months prior to this video, and MRI demonstrated hypothalamic enhancement at that time. Nine months prior to this video, he gradually noticed that he was unable to look down. Work-up for ischemic, infectious, inflammator...Image/MovingImage
10 Atypical ocular motor features (gaze-evoked nystagmus) in PSPThis 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
11 The Apogeotropic Variant of Horizontal Canal BPPVThis 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 ground) HC BPPV, by rapidly moving from a sitting to a supine position with the h...Image/MovingImage
12 Bilateral INOs and partial 3rd nerve palsiesThis 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
13 Anti-GAD Associated Cerebellopathy and Bilateral VestibulopathyThis 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
14 Bilateral 6th nerve palsies due to idiopathic intracranial hypertensionThis 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
15 Bilateral INOs Due to StrokeThis 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...Image/MovingImage
16 The Bedside Examination of the Ocular Motor SystemA masterclass covering the bedside examination of the ocular motor system.Image/MovingImage
17 Bilateral Vestibular Loss With Gaze-Evoked Nystagmus and Saccadic Visually Enhanced VORThis 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...Image/MovingImage
18 Bruns Nystagmus Due o a Cerebellopontine Angle TumorThis 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 neural integrator/gaze holding apparatus) by the CPA mass, there was left-beat...Image/MovingImage
19 Bilaterally Abnormal Head Impulse TestThis 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/bouncing of the visual world while walking Typical signs in BVL: abnormal HIT to...Image/MovingImage
20 Gaze-Evoked Nystagmus & Slow Saccades Due to Anti-GAD Antibodies in a Patient with Stiff Person SyndromeThis is a 70-year-old woman with a several year long history of imbalance and stiffness. Exam demonstrated axial and lower extremity stiffness, and ocular motor exam demonstrated gaze-evoked nystagmus (e.g., right-beating in right gaze, left-beating in left gaze, up-beating in up gaze), and mild to ...Image/MovingImage
21 Evaluation of ConvergenceThe assessment of convergence includes measuring alignment at near versus distance (see video, https://collections.lib.utah.edu/details?id=187677), near point of convergence and convergence amplitude. Near point of convergence is assessed by bringing a fixation target toward the bridge of the patie...Image/MovingImage
22 Central Acute Vestibular Syndrome Due to Posterior Fossa HemorrhageThis 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
23 Central HINTS (With an Abnormal Head Impulse Sign) in the Acute Vestibular Syndrome Due to Lateral Pontine/Middle Cerebellar Peduncle DemyelinationThis is a 30-year-old man presenting with vertigo, diplopia and mild left facial weakness (not seen in the video). On exam, there was right-beating nystagmus (RBN) in primary gaze that increased in right gaze (in accordance with Alexander's law), and the RBN stayed unidirectional, but lessened, in l...Image/MovingImage
24 Chiari Malformation Causing Downbeat Nystagmus in Lateral GazeThis 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
25 Chronic Facial Nerve Palsy with Aberrant RegenerationThis is a 35-year-old woman who was diagnosed with right sided Bell's palsy six months prior. Contrast-enhanced MRI at that time was normal. This video demonstrates the phenomenon of aberrant regeneration (synkinesia) of the facial nerve. Due to aberrant regeneration, at rest the right palpebral fi...Image/MovingImage
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