NOVEL - Daniel Gold Collection
 
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1 Horizontal Gaze Palsy, Facial Nerve Palsy, and Nystagmus Due to Dorsal Pontine Ischemia𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: Presented here are two patients with horizontal gaze and facial palsies due to stroke. The first patient is a 60-year-old man who presented with double vision and hemiparesis due to a right dorsal pontine ischemic stroke....Image/MovingImage
2 3rd Nerve Palsy With Preserved 4th Nerve Function80-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
3 The Acute Vestibular Syndrome in MS Due to Middle Cerebellar Peduncle/Root Entry Zone LesionThis 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
4 Bilateral Horizontal Gaze Palsy and Oculopalatal Tremor Due to Pontine HemorrhageThis 70-yo-woman experienced headache and diplopia and was found to have a hemorrhage centrally within the dorsal pons. Months after the onset, the patient was seen in clinic and had no horizontal eye movements (pursuit, saccades, VOR) in either eye, suggestive of bilateral nuclear 6th nerve palsies...Image/MovingImage
5 Complete Peripheral Vestibulopathy & Ipsilateral Facial Palsy𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: 60-yo-man who suffered the fairly abrupt onset (over hours) of right lower motor neuron facial nerve palsy (7th cranial nerve), vertigo and deafness in the right ear (8th cranial nerve). Vesicles were noted on otoscopy, a...Image/MovingImage
6 Latent Nystagmus and DVD in Infantile EsotropiaThis is a 20-year-old woman with infantile esotropia (s/p strabismus surgery as a child) who demonstrated latent nystagmus and presumed dissociated vertical deviation (DVD) OS, which are commonly seen with infantile esotropia (also inferior oblique overaction and monocular nasotemporal asymmetry to ...Image/MovingImage
7 Medial Medullary SyndromesThis is a video of two patients who suffered small strokes involving the right medial medulla, and who presented with acute vertigo and oscillopsia. The first patient in the video had pure upbeat nystagmus, while the second patient had upbeat-torsional (towards the right ear) nystagmus in addition t...Image/MovingImage
8 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
9 Unidirectional Nystagmus in Lateral Medullary SyndromeThis is a 70-yo-man who presented with acute vertigo. Examination demonstrated very mild spontaneous torsional nystagmus (towards the right ear) in primary (not seen well in this video), with robust downbeat-torsional (towards right ear) nystagmus in right gaze and (less robust) almost pure torsiona...Image/MovingImage
10 Unidirectional Vestibular Nystagmus60-yo-man with recurrent vertigo attacks - this video was taken during one of his typical attacks, and shows left-beating nystagmus that stayed left-beating in all directions of gaze, more in left gaze (in accordance with Alexander's Law), and less in right gaze. This pattern is more commonly seen w...Image/MovingImage
11 Wallenberg Syndrome in MS𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: 30-yo-woman with MS presenting with acute vertigo and vertical diplopia. Examination demonstrated several aspects of the Wallenberg syndrome (her acute demyelinating lesion was in the left lateral medulla): ipsilesional (...Image/MovingImage
12 Downbeat Nystagmus and Convergence SpasmThis is a 60-yo-woman with vertical oscillopsia related to her downbeat nystagmus, and diplopia related to an intermittent esotropia. When the esotropia was present, with versions there were bilateral abduction deficits. With ductions and the vestibulo-ocular reflex, it was apparent that the range o...Image/MovingImage
13 Idiopathic Downbeat Nystagmus, Decreasing with ConvergenceThis is a 25-yo-woman who experienced vertically oscillopsia for 1 year, and was found to have downbeat nystagmus. Interestingly, there were no other cerebellar ocular motor signs - e.g., normal saccades, smooth pursuit, VOR suppression, and no gaze-evoked nystagmus, although her (pure) downbeat was...Image/MovingImage
14 Cerebellar Degeneration with Downbeat Nystagmus Provoked by ConvergenceDescription: This is a 70-yo-woman with a progressive gait disorder, diagnosed with cerebellar ataxia. She displayed typical cerebellar ocular motor signs including gaze-evoked nystagmus, choppy pursuit and VOR suppression, and there was very subtle spontaneous downbeat nystagmus, best appreciated w...Image/MovingImage
15 Traumatic 3rd Nerve Palsy with Aberrant Regeneration𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 20-yo-woman who experienced severe head trauma and diplopia upon awakening from a coma several weeks after the injury. She had a partial left 3rd nerve palsy (adduction spared), and when she looked to the right ...Image/MovingImage
16 Aberrant Regeneration of the 3rd NerveAberrant regeneration in two patients: 1) a young woman with a right cavernous sinus meningioma with subsequent development of aberrant regeneration demonstrated by eyelid elevation OD in attempted downgaze (i.e., some fibers that were supposed to innervate the right IR were misrouted to the right l...Image/MovingImage
17 Elliptical Pendular Nystagmus in MS𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 40-yo-woman with MS and bilateral optic nerve disease who presented with a year's long history of oscillopsia, which was related to elliptical pendular nystagmus. The appearance of elliptical nystagmus is the re...Image/MovingImage
18 Idiopathic Downbeat Nystagmus Exacerbated with Positional Maneuvers𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 45-yo-woman with vertical oscillopsia for 6+ months, found to have downbeat nystagmus on examination. She mainly complained of dizziness and oscillopsia when laying down. She was found to have a significant exac...Image/MovingImage
19 Cerebellar Eye Signs in SCA8𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 30-yo-man with a diagnosis of SCA 8 who had appendicular and gait ataxia in addition to choppy smooth pursuit and VORS, downbeat nystagmus, saccadic hypermetria, and gaze-evoked nystagmus with rebound nystagmus....Image/MovingImage
20 Vertical-Torsional Pendular Nystagmus and Convergence Spasm Due to Anti-MaTa EncephalitisThis is a 50-yo-woman with debilitating oscillopsia due to a high frequency (6 Hz) vertical-torsional pendular (quantitative eye movement recordings were performed) nystagmus. She also had intermittent double vision due to (organic) convergence spasm. Her nystagmus and spasm were thought to be relat...Image/MovingImage
21 Gaze-evoked and Rebound Nystagmus in a Cerebellar Syndrome𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: 30-yo-man with the subacute onset of a cerebellar syndrome. After extensive evaluation and progression, it was thought that this represented an autoimmune process and there was some improvement with immunosuppression. He ...Image/MovingImage
22 Typical Lid Signs (Cogan's Lid Twitch, Lid Hopping, Enhanced Ptosis) in Myasthenia Gravis𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 60-yo-woman with MG who displays typical eyelid signs including Cogan's lid twitch, lid hopping (appreciated during horizontal smooth pursuit in this patient), and enhanced ptosis in accordance with Hering's law...Image/MovingImage
23 Prolonged Lid Twitch in Myasthenia GravisThis 50-yo-woman with ocular MG demonstrated a spontaneous and particularly prolonged eyelid twitch.Image/MovingImage
24 Wall-eyed Bilateral INO in Caudal Midbrain LesionThis is a 30-yo-woman with the relatively acute onset of diplopia. There was a large angle exotropia, very subtle lag of the adducting saccades OD>OS, suggestive of bilateral INOs. This was best seen with rapid horizontal saccades, and a lesion involving bilateral MLFs in the caudal midbrain was dem...Image/MovingImage
25 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
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