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Title | Description | Type |
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Unilateral 3rd, 4th, and 6th Nerve Palsies Due to Cavernous Sinus Meningioma | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 50-year-old woman presenting with a partial 3rd nerve palsy (mild pupil involvement), partial 6th nerve palsy, and no clear incyclotorsion with downgaze, suggestive of additional 4th nerve palsy, all on the left... | Image/MovingImage |
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3rd Nerve Palsy With Preserved 4th Nerve Function | 80-yo-woman with a left vasculopathic 3rd nerve palsy (minimal pupil involvement of about 1 mm relative mydriasis OS - other etiologies ruled out and resolved as expected over months). Although the inferior rectus is paretic, intact superior oblique muscle function can be demonstrated by asking the ... | Image/MovingImage |
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Cavernous Sinus Mass Causing Right 3rd and 4th Nerve Palsies | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: 25-yo-man who complained of diplopia and was initially found to have right 4th and 6th nerve palsies in the setting of a right cavernous sinus mass (subsequently diagnosed as Ewing's sarcoma). When seen in follow-up (this... | Image/MovingImage |
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Central 4th Nerve Palsy with Contralateral Horner's Syndrome | This is a 60-yo-woman who presented with a complaint of diplopia. Examination demonstrated a left hypertropia that worsened in right and down gaze as well as in left head tilt, and a left 4th nerve palsy was diagnosed. There was also evidence of a mild motility deficit in down/medial gaze OS, consis... | Image/MovingImage |
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6th Nerve Palsy as Initial Presentation of Metastatic Lung Cancer | A video describing 6th nerve palsy as initial presentation of metastatic lung cancer. | Image/MovingImage |
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Anterior Canal - BPPV: Deep Head Hanging | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: Regardless 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 posi... | 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 |
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Slow Horizontal, Vertical, Oblique Saccades and Gaze-evoked Nystagmus in Anti-AGNA-1 Encephalitis | This is a patient who presented subacutely with imbalance and dizziness. On examination, she had evidence of gaze evoked nystagmus, right internuclear ophthalmoplegia, as well as slow saccades horizontally and vertically. She was diagnosed with a rare antibody-mediated disorder, anti-AGNA-1 (antig... | Image/MovingImage |
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The Acute Vestibular Syndrome in MS Due to Middle Cerebellar Peduncle/Root Entry Zone Lesion | This is a 13 year-old girl with relatively abrupt onset vertigo and oscillopsia. On exam, there was primarily right-beating nystagmus in primary gaze with a slight upward (upbeat) component, giving the nystagmus an oblique appearance. The upward component and lack of a clear torsional component acut... | Image/MovingImage |
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A 'Canal Jam' During Head Impulse Testing in a Patient With Horizontal Canal BPPV | A 70-year-old man reported brief episodes of positional vertigo. Ten years prior, he had undergone gamma knife radiosurgery for a vestibular schwannoma at the left cerebellopontine angle. Video head impulse testing (vHIT) showed reduced gains and corrective saccades in the planes of the left horizon... | Image/MovingImage |
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Abnormal Active Head Impulse Testing Recorded Asynchronously in Bilateral Vestibular Loss | This 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 |
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Abnormal Head Impulse Test in Vestibular Neuritis 1 Week After Onset | This 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 |
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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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Acquired Elliptical Pendular Nystagmus Suppressed by Blinks and Saccades | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 70-year-old man who experienced the gradual onset of oscillopsia over weeks about 3 months prior to this video recording. Examination demonstrated elliptical pendular nystagmus which was atypical for infantile n... | Image/MovingImage |
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Active Head Impulse Test | Active head impulse test (HIT): instruct the patient to fix their eyes on the camera and turn their head 20o to the right/left, and then make a rapid movement toward the midline to align their head with the camera again, keeping their eyes fixed on the camera throughout. A simple instruction is to a... | Image/MovingImage |
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Acute Vestibular Neuritis With Unidirectional Nystagmus and Abnormal Video Head Impulse Test | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This 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, cons... | Image/MovingImage |
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Common Neuro-Ophthalmic Ancillary Tests to Assist in the Diagnosis and Localization of Afferent Disorders | Chart of the common neuro-ophthalmic ancillary tests to assist in the diagnosis and localization of afferent disorders. | Text |
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Alternating Hypertropias - Bilateral 4th Nerve Palsies and Alternating Skew Deviation | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: Seen 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... | Image/MovingImage |
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Central Vestibular Nystagmus in Anti-DPPX Encephalitis | This is a young woman who presented with oscillopsia due to spontaneous nystagmus in addition to gastrointestinal symptoms which led to the diagnosis of anti-DPP axis encephalitis. She was treated with rituximab, and experience gradual improvement over time. However, years after the onset, she con... | Image/MovingImage |
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Vertical Gaze Palsy and Saccadic Intrusions Due to Anti-Ri from Head and Neck Carcinoma | A 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 |
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Nystagmus Due to Paraneoplastic (Anti-Yo) Brainstem and Cerebellar Degeneration | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This 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 nys... | Image/MovingImage |
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Apogeotropic and Downbeat Central Positional Nystagmus Provoked While Seated | This is a young man with intermittent complaints of positional vertigo. With Dix-Hallpike and roll testing, he had apogeotropic positional nystagmus (e.g., right beating nystagmus with the left ear down, and left beating nystagmus with the right ear down) in addition to strong downbeat nystagmus in... | Image/MovingImage |
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A flowchart approach to nystagmus/intrusions | In tandem with the flowchart, the following added clues should be used to help with etiology: i) vector [horizontal, vertical, torsional]; ii) binocular or monocular; iii) spontaneous or provoked [e.g., BPPV]; iv) change with monocular viewing or gaze direction; v) rest of history, neurologic, and o... | Image/StillImage |
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Approach to the Ocular Motor and Vestibular History and Examination | History and examination of ocular motor and vestibular. | Text |
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Saccadic Smooth Pursuit and Vestibulo-ocular Reflex Suppression (VORS) | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 20-yo-man who suffered a left MCA stroke years prior. Upon evaluation of his eye movements, saccades and all classes of eye movements were normal, although his smooth pursuit and VORS were choppy to the left (ip... | Image/MovingImage |