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1 Cerebral Control of Eye MovementsIn this series, the purpose and nomenclature of eye movements are described, with the anatomical pathways generating and controlling the cortically-driven movements -- saccades and smooth pursuit in horizontal gaze, upgaze and downgaze -- discussed in detail. The importance of each of the three sac...Image/MovingImage
2 Cerebellar Eye SignsLesions of the cerebellum can result in a variety of eye movement disorders, including saccadic intrusions and oscillations, such as ocular dysmetria, as well as nystagmus, gaze palsies, and dysfunction of the vestibular ocular reflex. In this series of videos, these disorders are discussed in rela...Image/MovingImage
3 Brain Stem Eye Movement SyndromesIn this series, the importance of the brainstem in eye movements is discussed, with particular emphasis is placed on the signficance of the paramedian pontine reticular formation (PPRF), the medial longitudinal fasciculus (MLF), and the nuclei and projections of cranial nerves III and VI. Correlat...Image/MovingImage
4 Miscellaneous Ocular OscillationsIn this final series, several eye movement abnormalities are detailed with patients used to illustrate each. KEY WORDS: opsoclonus-myoclonus, opsoclonus, square wave jerks, macro square wave jerks, pause cell dysfunction, voluntary nystagmus, eyelid nystagmus, see-saw nystagmus, superior oblique my...Image/MovingImage
5 Defective PursuitA patient with a cerebral hemispherectomy manifests ipsilateral low-gain (saccadic) pursuit, and impaired optokinetic nystagmus when the targets are moved towards the lesioned side. The multiple causes of pursuit abnormalities are discussed.Image/MovingImage
6 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
7 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
8 Pursuit SystemThe anatomical pathways of smooth pursuit are described, stressing the importance of the cerebellum that, in contrast to the saccadic system, relays information between the cortex and brain stem. The outcomes of specific cortical lesions are discussed and the important concept of gain is introduced.Image/MovingImage
9 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
10 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
11 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
12 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
13 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
14 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
15 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
16 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
17 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
18 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
19 Nystagmus NomenclatureA brief discussion of the various types of nystagmus is provided.Image/MovingImage
20 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
21 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
22 Pause Cell DysfunctionsThis reviews the ocular oscillations caused by pause cell dysfunctions.Image/MovingImage
23 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
24 Recording and Modeling Eye MovementsA brief discussion of the power and perhaps limitations of eye movement modeling is presented.Image/MovingImage
25 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
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