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TitleDescriptionType
226 Pons: 6th, 7th, 8th, and Middle Cerebellar Peduncle AnatomyFrom this cross-section of the pons, the proximity of the 7th and 8th fascicles can be appreciated, and a lateral inferior pontine syndrome (anterior inferior cerebellar artery territory), which could involve both of these fascicles, could cause acute prolonged vertigo accompanied by a + ipsilateral...Image
227 Pontine Hemorrhage Causing Oculopalatal Tremor and Multiple Cranial NeuropathiesThis is a 45-yo-woman who had a dorsal pontine cavernoma that bled 2 years prior to this video. Symptoms included diplopia and oscillopsia. On examination, she had left>right facial palsies (upper and lower face from involvement of the nucleus/fascicle - i.e., lower motor neuron palsies) and sixth n...Image/MovingImage
228 Positional Downbeat Nystagmus Mimicking Anterior Canal BPPVAlthough positional downbeat nystagmus (pDBN) can indicate the rare anterior canal variant of benign paroxysmal positional vertigo, central mimics are common causes of pDBN. pDBN may be seen in multiple system atrophy (MSA), or seen with posterior fossa lesions, with a common example being a stroke ...Image/MovingImage
229 Positional Nystagmus During an Attack of Vestibular Migraine𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: A 50-year-old woman presented to clinic after experiencing multiple episodes of hours-long vertigo attacks that were associated with headache, photophobia and phonophobia. She had a history of motion sickness and migraine...Image/MovingImage
230 Post-infectious Ocular Flutter and Myoclonus Syndrome𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This 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 w...Image/MovingImage
231 Posterior Canal BPPV Pre- and Post-Epley Maneuver𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a patient with typical right posterior canal benign paroxysmal positional vertigo (BPPV), which was provoked by the Dix-Hallpike maneuver. When the patient was moved into the right Dix-Hallpike maneuver, after a b...Image/MovingImage
232 Posterior Canal BPPV Treated with Semont ManeuverThis is a patient with left posterior canal (PC) benign paroxysmal positional vertigo (BPPV), and upbeat-torsional (towards the left ear) nystagmus was provoked by left Dix-Hallpike maneuver and left side-lying maneuver. This video demonstrates treatment of her left PC BPPV with the Semont maneuver....Image/MovingImage
233 Posterior Canal BPPV with Fixation and with Fixation RemovedThis is a 60-yo-woman with positional vertigo. In the right Dix-Hallpike position with fixation removed, there was clear upbeat-torsional nystagmus (towards the lowermost right ear) which led to the diagnosis of right posterior canal BPPV. In right Dix-Hallpike with fixation there was mainly torsion...Image/MovingImage
234 Pressure Testing for Superior Canal Dehiscence Syndrome𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: Superior semicircular canal dehiscence syndrome (SCDS) is caused by a third mobile window in the inner ear. This allows for transmission of sound or pressure to the superior canal. Tragal compression and/or glottic and ...Image/MovingImage
235 Prolonged Lid Twitch in Myasthenia GravisThis 50-yo-woman with ocular MG demonstrated a spontaneous and particularly prolonged eyelid twitch.Image/MovingImage
236 Provocative Maneuvers (Removal of Fixation, Vibration, Head-Shaking) to Accentuate Peripheral Vestibular Nystagmus)𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: With an acute destructive process like vestibular neuritis that causes significant unilateral vestibular loss, spontaneous nystagmus is always present. However, over days to months, spontaneous nystagmus should resolve co...Image/MovingImage
237 Pseudo-INOs in Myasthenia GravisThis is a 55-yo-woman with an intermittent exotropia who had normal adduction OU, but clear lag of adducting saccades OD>OS with rapid horizontal saccades. This was much more apparent after repeat testing (ie, it was fatigable), and she wound up having ocular MG.Image/MovingImage
238 Pseudo-Spontaneous Nystagmus and Bow and Lean Test in Horizontal Canal BPPV𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻:This is a 70-year-old woman presenting to the Emergency Department with positional vertigo that was determined to be due to the apogeotropic variant of right horizontal canal (HC) benign paroxysmal positional vertigo (BPPV...Image/MovingImage
239 Pseudonystagmus Due to Bilateral Vestibular Loss and Head Tremor𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This 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 cle...Image/MovingImage
240 PSP with Complete Ophthalmoplegia and Inability to Suppress the VOR𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 65-year-old woman presenting with visual complaints in the setting of advanced progressive supranuclear palsy (PSP). She had complete vertical and horizontal ophthalmoplegia, although the vestibulo-ocular reflex...Image/MovingImage
241 PSP with Vertical Gaze Palsy, Abnormal Optokinetic Nystagmus and Inability to Suppress Blinking to Light𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 75-year-old woman with a diagnosis of progressive supranuclear palsy (PSP). Examination demonstrated vertical supranuclear gaze palsy (i.e., it could be overcome by the vertical vestibulo-ocular reflex [VOR]), s...Image/MovingImage
242 Range of Motion (Ductions)Range of motion (ductions): check the range of each individual eye (ductions) if there is diplopia or if a motility deficit is suspected. Instructing the patient to hold their head 20o to the right or to the left may provide a better view of the range of horizontal gaze, if there is diplopia or if a...Image/MovingImage
243 Relationship Between Semicircular Canals and Extraocular MusclesFigure 1: When stimulated, each of the 6 angular acceleration detecting semicircular canals (3 on the right and 3 on the left) responds with a conjugate eye movement, with the vector(s) indicated below. PC=posterior canal; HC=horizontal (also known as lateral) canal; AC=anterior (also known as super...Image
244 Relative Afferent Pupillary Defect in Compressive Optic Neuropathy Due to Meningioma𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 35-year-old woman with a compressive optic neuropathy OS due to a meningioma. She had normal acuity and color OD, with 20/40 acuity and dyschromatopsia OS. There was loss of visual field OS with a mainly tempora...Image/MovingImage
245 Reversal of Vertical Nystagmus with Convergence in Anti-DPPX Encephalitis𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a man who initially presented with spontaneous upbeat and torsional nystagmus, which led to the diagnosis of anti-DPPX encephalitis (for further details on this patient's course and for a video of his nystagmus, s...Image/MovingImage
246 Right Dix Hallpike TestThe Dix-Hallpike tests for benign paroxysmal positional vertigo (BPPV). A test is positive when a patient reports vertigo, dizziness, or sensation of movement or falling with nystagmus present. When the head is in this position, it allows the posterior canal to be aligned with the gravitational vect...Text
247 Right Dix Hallpike Test (Video)The Dix-Hallpike tests for benign paroxysmal positional vertigo (BPPV). A test is positive when a patient reports vertigo, dizziness, or sensation of movement or falling with nystagmus present. When the head is in this position, it allows the posterior canal to be aligned with the gravitational vect...Image/MovingImage
248 Right Half Hallpike TestThe Half Hallpike Test compliments the Dix Hallpike Test and is traditionally used to assist with the diagnosis of posterior canal-benign paroxysmal positional vertigo (BC-BPPV), cupulolithiasis, as it may produce a greater degree of deflection under the action of gravity without latency when the ot...Text
249 Right Half Hallpike Test (Video)The Half Hallpike Test compliments the Dix Hallpike Test and is traditionally used to assist with the diagnosis of posterior canal-benign paroxysmal positional vertigo (BC-BPPV), cupulolithiasis, as it may produce a greater degree of deflection under the action of gravity without latency when the o...Image/MovingImage
250 riMLF Syndrome from Artery of Percheron Stroke𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 65-yo-man who suffered the abrupt onset of loss of consciousness followed by difficulty looking down. MRI showed bilateral rostral midbrain strokes in the distribution of the artery of Percheron. He could not in...Image/MovingImage
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