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1 Defective Saccades: Slow to No SaccadesIn this video, the many causes of this syndrome are listed, and a patient demonstrates the consequence of being unable to generate saccadic eye movements. On cold caloric stimulation, his eyes deviate tonically to the side of the stimulation without fast phases to the opposite side.Image/MovingImage
2 OpsoclonusThe differential diagnosis in adults is presented, followed by probably the most dramatic example of this disorder ever filmed. The father of American Neuro-ophthalmology, Dr. Frank Walsh, gave a copy of the film to Dr. J. Lawton Smith who, in turn, gave a copy to me.Image/MovingImage
3 Gaze Evoked Ear RetractionLarge ears normally retract during ipsilateral gaze, as shown in this segment. However, it won't be noted unless you look for it. "You see what you look for, and you look for what you know."Image/MovingImage
4 Classifications of Internuclear OphthalmoplegiaBoth the Lutz and Cogan classifications of INO separate them into anterior and posterior varieties. The Cogan classification, which depends upon the presence or absence of convergence, is not particularly useful for localization. The Lutz posterior INO, which is a supranuclear pareses of abduction, ...Image/MovingImage
5 Introduction to Eye MovementsThis brief clip reveals how eye movements subserve vision, and provides an overview of each of the four eye movement systems: saccadic, smooth pursuit, vergence, and vestibular.Image/MovingImage
6 Ocular DysmetriaUpon attempted refixation, patients with this cerebellar eye sign over-shoot and oscillate, before eventually reaching their intended targets. Two patients demonstrate this disorder.Image/MovingImage
7 Downbeat NystagmusPrimary position downbeat nystagmus is demonstrated, with a list of the common causes.Image/MovingImage
8 Anatomy and Physiology of the Saccade SystemSaccades depend on a pulse-step firing pattern that allows an initiation of the saccade (pulse), and maintenance of the new eye position in space (step). This video explains the anatomical pathway for this type of activation. The burst cells, which lie in the PPRF, generate the pulse, while the nu...Image/MovingImage
9 Normal Vertical Eye MovementsThe brain stem pathway for vertical saccades involves the PPRF, rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF), nucleus of Cajal, and the nuclei of cranial nerves III and IV. For upgaze, projections from the riMLF traverse through the posterior commissure, whereas there ...Image/MovingImage
10 Ocular BobbingThis is characterized by an initial fast phase downward, followed by a slow phase up, which is the reverse of nystagmus, where a corrective fast phase follows the slow phase. Most patients with bobbing have a large pontine lesion and are comatose with paralyzed horizontal eye movements. The patien...Image/MovingImage
11 One and Half SyndromeThis involves both gaze palsy secondary to a lesion of the ipsilateral PPRF or VI nucleus, and an INO secondary to a lesion of the MLF on the same side. If the VI nucleus is involved, VII palsy almost always occurs due to the proximity of the VII fascicle to the VI nucleus.Image/MovingImage
12 Psychogenic Gaze PalsyPsychogenic Gaze-Palsy is unusual but can usually be detected during Oculo-cephalics when the eyebrows don't elevate during attempted upward gaze.Image/MovingImage
13 See-saw NystagmusTwo patients with see-saw nystagmus are presented. The nystagmus is usually due to a suprasellar lesion associated with a bitemporal hemianopsia or a rostral midbrain lesion. The nystagmus is conjugate and torsional with a dissociated vertical vector so that the intorting eye rises and the extortin...Image/MovingImage
14 Macro Square Wave JerksA woman with multiple sclerosis has a postural tremor and macro square wave jerks. These indicate a cerebellar outflow problem. Macro square wave jerks are somewhat of a misnomer since the eye movements are not entirely square; an alternate descriptor is "square wave pulses."Image/MovingImage
15 Nystagmus NomenclatureA brief discussion of the various types of nystagmus is provided.Image/MovingImage
16 Eyelid NystagmusLid nystagmus is of three types. The most common is associated with vertical ocular nystagmus with the lid movement being synchronous with the eyes, but with greater aplitutde. The second type is associated with gaze evoked horizontal nystagmus and may occur in the lateral medullary syndrome. A p...Image/MovingImage
17 Wall-Eyed Internuclear OphthalmoplegiaSome patients with bilateral INOs are exotropic. Convergence is variable; it may be completely normal in both eyes, absent bilaterally, or present in one eye only.Image/MovingImage
18 Pause Cell DysfunctionsThis reviews the ocular oscillations caused by pause cell dysfunctions.Image/MovingImage
19 Voluntary NystagmusIn this video, a woman shows her ability to voluntarily induce an ocular oscillation. It is called "voluntary nystagmus", although the oscillation consist of back-to-back saccades, such as occurs in ocular flutter. Clues to the voluntary nature of this oscillation are mentioned. At times, however, ...Image/MovingImage
20 Saccadic SystemThe anatomical pathways of saccades are described. These primarily involve the frontal eye fields (FEF), mesencephalic reticular nuclei, pontine paramedian reticular formation (PPRF), and cranial nerve nuclei III, IV, and VI. The three saccadic generators in the cortex are in the contralateral FEF...Image/MovingImage
21 Accomodative Gaze Palsy or Convergence SpasmThis is a psychogenic disorder that may mimic lateral rectus palsy. The clue is pupillary constriction during attempted lateral gaze.Image/MovingImage
22 Recording and Modeling Eye MovementsA brief discussion of the power and perhaps limitations of eye movement modeling is presented.Image/MovingImage
23 Defective Saccades: Frontal Lobe LesionA patient with a right frontal lobe infarction demonstrates loss of saccades to the left with preservation of pursuit.Image/MovingImage
24 Ocular Palatal MyoclonusThe relevant anatomy of this disorder involves the inferior olivary nucleus, projecting via the restiform body to the contralateral dentate nucleus, traveling to the contralateral red nucleus via the superior cerebellar peduncle, and finally back to the inferior olivary nucleus via the central tegme...Image/MovingImage
25 Pause Cell Dysfunction: Ocular FlutterBurst neurons are tonically inhibited by the pause neurons, which lie in the nucleus raphe interpositus. Lesions of the pause neurons result in ocular flutter.Image/MovingImage
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