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TitleDescriptionType
1 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
2 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
3 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
4 Bilateral Horizontal Gaze PalsyA patient with a bilateral PPRF lesion displays intact vertical gaze and convergence.Image/MovingImage
5 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
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 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
8 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
9 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
10 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
11 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
12 Downbeat NystagmusPrimary position downbeat nystagmus is demonstrated, with a list of the common causes.Image/MovingImage
13 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
14 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
15 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
16 Periodic Alternating NystagmusA patient with PAN is shown with a discussion of its appearance and etiology.Image/MovingImage
17 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
18 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
19 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
20 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
21 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
22 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
23 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
24 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
25 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
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