NOVEL - Robert B. Daroff Collection
 
Filters: Collection: "ehsl_novel_rbd" Year End: 2014
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1 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
2 Alexander's LawThis describes the observed increase in vestibular nystagmus with gaze in the direction of the fast phase, and its decrease with gaze in the slow phase direction.Image/MovingImage
3 Anatomy and Physiology of NystagmusThe role of the cerebellum in modifying the output of the neural integrator is discussed. Impaired integration causes jerk nystagmus with increasing or decreasing velocity exponential slow phases.Image/MovingImage
4 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
5 Bilateral Horizontal Gaze PalsyA patient with a bilateral PPRF lesion displays intact vertical gaze and convergence.Image/MovingImage
6 Bilateral Internulcear OphthalmoplegiaA woman with a bilateral INO demonstrates impaired adduction and nystagmus of the abducting eyes. Her vertical gaze is intact. The dissociated optokinetic nystagmus, due to an inability of the medial recti to generate normal saccades, is again shown.Image/MovingImage
7 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
8 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
9 Cerebellar Eye Signs: OverviewThe wide array of cerebellar eye signs, includes, among others, saccadic intrusions and oscillations, nystagmus, gaze palsies, and impairment of the vestibulo-ocular reflex.Image/MovingImage
10 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
11 Chiari Malformation: Eye MovementsThe eye movement disorders commonly accompanying Chiari malformations are listed. These are generally the same as with lesions of the cerebellum.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 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
14 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
15 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
16 Downbeat NystagmusPrimary position downbeat nystagmus is demonstrated, with a list of the common causes.Image/MovingImage
17 Eye Movement Modeling; Eye-Ear TricksA surgical resident was able to combine eye and ear movements as a party trick, to intimidate a first year neurology resident.Image/MovingImage
18 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
19 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
20 Gustatory Lid Retraction in Congenital Horner's SyndromeA young girl with unilateral ptosis from a congenital Horner's syndrome demonstrates a distinctively rare phenomenon of resolution of the ptosis by sucking lemon juice.Image/MovingImage
21 Horizontal Eye MovementsThe anatomic pathway involved in horizontal saccadic eye movements include the frontal eye fields, paramedian pontine reticular formation (PPRF), medial longitudinal fasciculus (MLF), and cranial nerve nuclei III and VI. The pathway for the vestibulo- ocular reflex (VOR) passes through the PPRF at ...Image/MovingImage
22 Internuclear OphthalmoplegiaLesions of the MLF cause an INO, which manifests as ipsilateral palsies of adduction, and nystagmus of the contralateral abducted eye. Vertical gaze is preserved. Inducing optokinetic nystagmus so that the adducting eye is responsible for the fast phase, causes a dissociation between the two eyes, a...Image/MovingImage
23 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
24 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
25 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
26 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
27 Nystagmus NomenclatureA brief discussion of the various types of nystagmus is provided.Image/MovingImage
28 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
29 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
30 Ocular FlutterOcular Flutter, a disorder characterized by intermittent, rapid, horizontal movements in primary position, is demonstrated in this video.Image/MovingImage
31 Ocular Myasthenia GravisA man with limited ocular excursions and only small amplitude saccades, improves with Tensilon, this illustrates the need to always consider ocular myasthenia in the differential diagnosis in patients with limited eye movements. Rapid restricted saccades, as this patient demonstrates, are diagnosti...Image/MovingImage
32 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
33 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
34 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
35 Opsoclonus in an InfantAn infant with Infantile Opsoclonus-Myoclonus ("Dancing Eyes, Dancing Feet"), with a likely underlying neuroblastoma is shown and the differential diagnosis of opsoclonus in infants and children is listed.Image/MovingImage
36 Parinaud's Syndrome or Dorsal Midbrain SyndromeAlso known as the pretectal, or sylvian aqueduct syndromes, it is characterized by paralysis of upgaze to both saccades and pursuit. In this video, the causes of Parinaud's, along with its signs of large pupils with light-near dissociation, spastic-paretic accommodation, pathologic lid retraction (...Image/MovingImage
37 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
38 Pause Cell DysfunctionsThis reviews the ocular oscillations caused by pause cell dysfunctions.Image/MovingImage
39 Periodic Alternating NystagmusA patient with PAN is shown with a discussion of its appearance and etiology.Image/MovingImage
40 Progressive Supranuclear PalsyA patient with PSP demonstrates bilateral hypometric saccades, bilateral low-gain pursuit, vertical gaze palsy, and normal vestibulo- ocular reflexes. A second PSP patient is unable to make saccades or pursue horizontally. With optokinetic stimulation, the eyes move somewhat. Cold caloric stimula...Image/MovingImage
41 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
42 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
43 Recording and Modeling Eye MovementsA brief discussion of the power and perhaps limitations of eye movement modeling is presented.Image/MovingImage
44 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
45 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
46 Square Wave JerksThese are the most common ocular oscillations, since they occur in normals, particularly in the elderly and in many neurological disorders. They fall under a category called "saccades intrusions." A man with very subtle square waves is presented, followed by a woman with larger amplitude square wav...Image/MovingImage
47 Superior Oblique MyokymiaThis eye movement abnormality presents with intermittent monocular oscillopsia, often following a particular eye movement or head tilt. The examiner will often miss the abnormality unless it can be provoked. It represents a microtremor of a superior oblique muscle and usually responds to an anticon...Image/MovingImage
48 Up-beat Nystagmus with Palatal MyoclonusA woman who appears to have upbeat nystagmus is also noted to have palatal, labial, and sternocleidomastoid myoclonus.Image/MovingImage
49 Upbeat NystagmusA female patient with upbeating nystagmus that increases in amplitude with upward gaze is shown. This type of nystagmus commonly occurs from a lesion involving one of three regions: the ponto-medullary junction, ponto-mesencephalic junction, and the anterior cerebellum. Etiologies of these lesions...Image/MovingImage
50 Various Causes of OphthalmoplegiaAs a resident, I missed the diagnoses of Ocular-Myasthenia Wernicke's, and Thyroid Eye Disease. To remind myself to consider these etiologies, I developed the "3 T's: Tensilon, Thiamine, and Thyroid. As the years past, I added two more T's: Tropia and Trauma.Image/MovingImage
51 Vertical Gaze ParalysisA patient is shown with up, down, and leftward gaze palsies as a result of a presumed right-sided high midbrain lesion. (He was encountered prior to the introduction of CT scanning, so that localization could not be verified). He had normal vestibulo-ocular reflexes. In addition, he had a curious ...Image/MovingImage
52 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
53 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
54 Whipples Mimicking PSPA patient is shown with nuchal dystonic ridigity, profound retropulsion, limited range of horizontal saccades, an almost complete vertical gaze palsy, normal vestibulo-ocular eye movements, and apraxia of eyelid opening. His pendular convergence nystagmus was the clue that he had CNS Whipple's Dise...Image/MovingImage
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