NOVEL - Daniel Gold Collection
 
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TitleDescriptionSubject
1 Assessing for Hyperventilation-induced Nystagmus𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: Hyperventilation induced nystagmus is tested by asking the patient to take quick deep breaths (~1/s) for 40-60 seconds. This decreases ICP and increases CSF pH. This can be helpful in diagnosing irritative conditions of ...Hyperventilation
2 Dynamic Visual Acuity𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: After assessing static binocular visual acuity, dynamic visual acuity (DVA) is determined by repeating the test during horizontal and vertical head shaking at 2-3 Hz. Dynamic visual acuity is most important to test when ...Dynamic Visual Acuity
3 Evaluation of Auditory Function Using Rinne and Weber Tests𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: The Rinne test is an assessment of auditory thresholds to air and bone conduction of sound. The Weber test is a comparison of bone conducted sound of either ear. Conductive hearing loss results in a loss of air conducte...Auditory Testing
4 Evaluation of Convergence𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: The 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 conve...Normal Convergence
5 Eyelid NystagmusLid nystagmus is a rhythmic eyelid movement commonly seen as an epiphenomenon of vertical nystagmus (typically upbeating, as in this case) due to a shared central pathway controlling elevation of the lid and supraduction. There can be isolated lid nystagmus if there is accompanying impairment of su...Nystagmus; Eyelid Nystagmus
6 Measuring Divergence AmplitudeDivergence insufficiency should be suspected in patients with binocular horizontal diplopia at distance (but not near) who lack abduction deficits. There should be an esodeviation greater at distance, and in older patients with levator dehiscence (or previous ptosis surgery) and prominent superior s...Insufficient Divergence
7 Ocular Motor & Vestibular Features of the MLF Syndrome𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This 61-year-old woman with HTN and DM presented for evaluation of acute onset diagonal diplopia. Adduction OS was about 60% of normal while medialization OS improved with convergence. In right gaze, dissociated abducti...INO; Jerk Nystagmus; Torsional Nystagmus; Gaze-evoked Nystagmus
8 Ocular Motor & Vestibular Features of the MLF Syndrome (Figures 1, 2, and 3)This 61-year-old woman with HTN and DM presented for evaluation of acute onset diagonal diplopia. Adduction OS was about 60% of normal while medialization OS improved with convergence. In right gaze, dissociated abducting nystagmus was present OD, and there was a clear adduction lag when asking he...INO; Jerk Nystagmus; Torsional Nystagmus; Gaze-Evoked Nystagmus
9 Ocular Motor Signs in Early Progressive Supranuclear Palsy𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 64-year old man who experienced imbalance and falls (usually backwards) for the last 6 months. He experienced difficulty navigating stairs and had become a messy eater (thought to be in large part due to his ver...Abnormal Saccades; Abnormal Convergence; Abnormal Pursuit; Abnormal Range; Abnormal VORS; Vertical Gaze Palsy; Downgaze Palsy; OMS Mesencephalon
10 Oculopalatal Tremor and Internuclear Ophthalmoplegia Due to Hemorrhagic Pontine Cavernoma𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 60-year-old woman who experienced 2 episodes of vertigo, nausea and vomiting, which was felt to be related to recurrent hemorrhage of a pontine cavernoma that was adjacent to the fourth ventricle. The cavernoma ...Pendular Nystagmus; Oculopalatal Tremor; INO; Pons OMS; Seventh Facial Nerve
11 Oculopalatal Tremor and One-and-a-Half Syndrome Due to Pontine Hemorrhage𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 65-year-old man who was put on a blood thinner, and shortly thereafter experienced a midline pontine hemorrhage, which was more dense on the left side. Immediately afterwards, right hemiparesis and hemi-anesthes...Pendular Nystagmus; Oculopalatal Tremor; INO; One-and-a-Half; Pons OMS; Seventh Facial Nerve; Sixth Abducens Nerve
12 Oculopalatal Tremor with Prominent Nystagmus, Bilateral Horizontal Gaze Palsy, and Bilateral Facial Palsies𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 50-year-old woman who experienced the acute onset of right sixth and seventh nerve palsies and left hemiparesis. Two cavernomas within the right pons (one in the region of the facial colliculus) were demonstrat...Abnormal Range; Sixth Nerve Palsy; Facial Nerve; Horizontal Gaze Palsy; OMS Pons; Pendular Nystagmus; Oculopalatal
13 Oculopalatal Tremor with Prominent Nystagmus, Bilateral Horizontal Gaze Palsy, and Bilateral Facial Palsies (Figure 1)Figure 1, MRI T2 sequence demonstrating hyperintensities involving bilateral inferior olives of the medulla. This is a 50-year-old woman who experienced the acute onset of right sixth and seventh nerve palsies and left hemiparesis. Two cavernomas within the right pons (one in the region of the facia...Abnormal Range; Sixth Nerve Palsy; Facial Nerve; Horizontal Gaze Palsy; OMS Pons; Pendular Nystagmus; Oculopalatal
14 Optokinetic Nystagmus𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: During the bedside evaluation of optokinetic nystagmus (OKN), the patient is instructed to look at each red (or white) square as it moves past. Because this is not a full-field visual stimuli, using an optokinetic flag m...Optokinetic Nystagmus
15 Paraneoplastic Downbeat Nystagmus and Cerebellar Ataxia Due to Small Cell Lung Carcinoma𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 61-year-old woman (non-smoker) who developed a gait disorder, dizziness and oscillopsia that was progressive over 2 months. Exam demonstrated spontaneous downbeat nystagmus with side pocket nystagmus in lateral ...Jerk Nystagmus; Downbeat Nystagmus; Cerebellar Ataxia; Carcinoma
16 Pendular, Gaze-Evoked and Abducting Nystagmus in MSThis is a 40-year-old woman with a history of multiple sclerosis who presented for oscillopsia. On examination, she had bilateral internuclear ophthalmoplegia (INO-adduction lag OU and abducting nystagmus OU), with a corresponding exotropia that increased in right and left gaze. She also had horiz...Jerk Nystagmus; INO; Pendular Nystagmus; Abducting Nystagmus; Gaze-Evoked Nystagmus; Cerebellar OMS
17 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 ...Valsalva; Superior Canal Dehiscence Syndrome
18 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...Headshaking Nystagmus
19 Rotary Chair Testing𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: Rotary chair testing includes rotation around a vertical axis, and evaluates the horizontal semicircular canal vestibulo-ocular reflex (VOR). The patient sits in a mechanized chair with the head secured in a neutral posi...Normal VOR; Abnormal VOR; Vestibular Lab Testing; Rotary Chair
20 Skew Deviation and Spontaneous Nystagmus Due to Posterior Fossa LesionsThis is a 50-year-old woman who reported the abrupt onset of imbalance, right upper extremity incoordination and binocular vertical diplopia several months prior to her presentation to our clinic. On examination, she had a left hypertropia that was fairly comitant (measuring 5 prism diopters) assoc...Abnormal Alignment; Jerk Nystagmus; Upbeat Nystagmus; Vestibular Nystagmus; Rotary Nystagmus; Skew Deviation
21 Slow Saccades Due to Unilateral Paramedian Pontine Reticular Formation (PPRF) Injury with Preserved Movements Using the Vestibulo-Ocular Reflex𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 60-year-old man who presented for imbalance and oscillopsia 10 months after surgery and 8 months after radiation for Merkel cell carcinoma of the neck. He developed imbalance after surgery and diplopia and osci...Abnormal Saccades; Pons OMS; Sixth Abducens Nerve; Abnormal VOR; Vestibulocochlear Nerve; Horizontal Gaze Palsy
22 Slow Volitional Saccades and Poor Fast Phases to an Optokinetic Stimulus, with Preserved Head Impulse TestingThis is a 67-year-old woman presenting with imbalance and binocular horizontal diplopia at near. On examination there were frequent square wave jerks, limited supraduction OU and convergence insufficiency, which explained her diplopia. Pursuit and suppression of the vestibulo-ocular reflex were sa...Abnormal Saccades; VOR HIT Normal
23 Summary of the Most Common Audio-Vestibular TestingChart describing common audio-vestibular testing.Vestibular Lab Testing
24 Test Your Knowledge - Bilateral 4th Nerve PalsiesWatch the video until instructed to stop. Which of the following features is likely to be present given her exam findings? A. Gaze-evoked nystagmus and impaired smooth pursuit B. History of traumatic brain injury C. History of blepharoplasty or brow lift surgery and prominence of superior sulcus on ...Abnormal Alignment; Fourth Nerve; Trochlear Nerve
25 Test Your Knowledge - Optokinetic Nystagmus with a Parietal Lesion𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: Given the finding seen in the first part of the video, which of the following associated features are most likely? (more than one answer may be correct) A. Left homonymous visual field defect B. Right homonymous visual fi...Abnormal OKN; Jerk Nystagmus
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