NOVEL - Daniel Gold Collection
 
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226 Test Your Knowledge - Central and Peripheral Vestibular and Ocular Motor Signs Due to a Large Vestibular SchwannomaWhich of the following is least likely to be the correct localization or etiology given the findings seen in the video? 1) Acute right 8th cranial neuropathy 2) Right-sided vestibular schwannoma 3) Right vestibular nucleus infarction 4) Right anterior inferior cerebellar artery distribution stroke A...Image/MovingImage
227 Downbeat Nystagmus and Cerebellar AtrophyThis is a 40-year-old man with 2 years of progressive ataxia and oscillopsia. On examination, he had downbeat nystagmus (DBN), an ocular motor finding that is usually (but not always) associated with flocculus/paraflocculus dysfunction, which causes overaction of the anterior canal (upward or anti-g...Image/MovingImage
228 Test Your Knowledge - Vertical Saccadic Palsy Due to Bilateral riMLF InfarctionsThis is a 30-year-old who was found minimally responsive on the lounge floor of an ice skating rink. He was brought to the ED, where he had a GCS score of 8 (where 15 is normal) for poor responsiveness. His ocular motor exam is shown in the video. Regarding Finding #1, which of the following is fals...Image/MovingImage
229 Square Wave Jerks and Macrosaccadic Oscillations in a Patient with a Cerebellar TumorThis is a 40-year-old man who developed severe headaches, confusion, and gait imbalance which led to neuroimaging which demonstrated a midline cerebellar mass with compression of the fourth ventricle and obstructive hydrocephalus. He underwent a suboccipital craniectomy for resection of the mass, an...Image/MovingImage
230 Ocular Dipping and Ping-pong Gaze Due to Bi-hemispheric StrokesThis is a 51-year-old man presenting with hypertensive left thalamic intracerebral hemorrhage and intraventricular hemorrhage, with course complicated by multifocal supratentorial ischemic strokes. He developed abnormal movements characterized by slow, conjugate, horizontal deviations, consistent wi...Image/MovingImage
231 Ocular Alignment𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: These tests allow for detection of eso-, exo- or hyperdeviations (phorias (one eye viewing) or tropias (both eyes viewing) that can be seen with ocular motor palsy, skew deviation, or with cerebellar disease (commonly eso...Image/MovingImage
232 Superior Oblique Myokymia (SOM)𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a patient with transient monocular oscillopsia OD and vertical diplopia noted to have many episodes of SOM in the office. There was not only myokymia OD, but also a 4 prism diopter left hypertropia during episodes...Image/MovingImage
233 Dix-Hallpike Maneuver in Posterior BPPV with Reversal of Nystagmus on Sitting Up𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a patient with typical posterior canal (PC) benign paroxysmal positional vertigo (BPPV), which is provoked by the Dix-Hallpike maneuver. When the patient is moved into the right Dix-Hallpike maneuver, after a brie...Image/MovingImage
234 Acute Vestibular Neuritis With Unidirectional Nystagmus and Abnormal Video Head Impulse Test𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is 45-year-old man who presented to the emergency department (ED) 2 days prior to this video recording with acute onset prolonged vertigo, nausea, head motion intolerance, unsteadiness and spontaneous nystagmus, cons...Image/MovingImage
235 + HIT, + Skew, Unidirectional Nystagmus: Central Acute Vestibular Syndrome Due to Wallenberg SyndromeThis is a 45-year-old woman who presented to the ED with acute prolonged vertigo and vertical diplopia. She was seen as an outpatient 1 month after her ED visit, and double vision and balance were improving by that time. Her HINTS testing showed the following (seen in the video): 1) Head Impulse - A...Image/MovingImage
236 A 'Canal Jam' During Head Impulse Testing in a Patient With Horizontal Canal BPPVA 70-year-old man reported brief episodes of positional vertigo. Ten years prior, he had undergone gamma knife radiosurgery for a vestibular schwannoma at the left cerebellopontine angle. Video head impulse testing (vHIT) showed reduced gains and corrective saccades in the planes of the left horizon...Image/MovingImage
237 Central Vestibular Nystagmus in Anti-DPPX EncephalitisThis is a young woman who presented with oscillopsia due to spontaneous nystagmus in addition to gastrointestinal symptoms which led to the diagnosis of anti-DPP axis encephalitis. She was treated with rituximab, and experience gradual improvement over time. However, years after the onset, she con...Image/MovingImage
238 Sagging Eye Syndrome and Cerebellar Disease in Divergence Insufficiency𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 70-year-old woman who presented with diplopia at distance. Her exam demonstrated orthophoria at near with a fairly comitant 8-10 PD esotropia at distance without abduction paresis, consistent with divergence ins...Image/MovingImage
239 Measuring Divergence AmplitudeDivergence insufficiency should be suspected in patients with binocular horizontal diplopia at distance (but not near) who lack abduction deficits. There should be an esodeviation greater at distance, and in older patients with levator dehiscence (or previous ptosis surgery) and prominent superior s...Image/MovingImage
240 Periodic Alternating Nystagmus and Perverted Head-shaking Nystagmus in Cerebellar Degeneration𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 60-yo-woman with several years of worsening imbalance, diplopia (hers was actually unrelated to cerebellar pathology [although she did have an esotropia greater at distance that was cerebellar in origin] and due...Image/MovingImage
241 The Acute Vestibular Syndrome with Skew Deviation, Gaze-evoked Nystagmus, and Bilaterally Abnormal Head Impulse Testing Due to AICA StrokeThis is a 60-year-old man with the acute onset of prolonged vertigo and nystagmus, consistent with the acute vestibular syndrome (AVS). HINTS (Head Impulse, Nystagmus, Test of Skew) exam demonstrated a central pattern: 1) Head impulse test (HIT) was abnormal to the right and to the left. An abnormal...Image/MovingImage
242 Paraneoplastic Downbeat Nystagmus and Cerebellar Ataxia Due to Small Cell Lung Carcinoma𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 61-year-old woman (non-smoker) who developed a gait disorder, dizziness and oscillopsia that was progressive over 2 months. Exam demonstrated spontaneous downbeat nystagmus with side pocket nystagmus in lateral ...Image/MovingImage
243 Abnormal Visually-Enhanced VOR in Cerebellar Ataxia, Neuropathy, Vestibular Areflexia Syndrome (CANVAS)A 67 year old woman presented with 1 year of progressive numbness, gait instability, and oscillopsia when walking or with head movements. Examination showed excessive square-wave jerks, bilateral horizontal gaze-evoked nystagmus, impairment of the visually-enhanced vestibular ocular reflex (vVOR - s...Image/MovingImage
244 Nystagmus Due to Paraneoplastic (Anti-Yo) Brainstem and Cerebellar Degeneration𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 40-yo-woman with anti-Yo antibody associated with ovarian cancer. Initial symptoms 2.5 years prior (to this video) included imbalance and dysarthria. She complained of oscillopsia which was due to her upbeat nys...Image/MovingImage
245 Sequential Vasculopathic 3rd Nerve Palsies with Preserved 4th Nerve Function65-yo-man with uncontrolled diabetes who developed sequential vasculopathic 3rd nerve palsies. In attempted downgaze, there's clear incyclotorsion OU suggestive of preserved 4th nerve function on both sides. There was complete recovery over months. Video shows bilateral 3rd nerve palsies with intact...Image/MovingImage
246 The Acute Vestibular Syndrome with Dysarthria, Dysphagia, Dysphonia, Hemi-ataxia, and Saccadic Dysmetria Due to the Lateral Medullary (Wallenberg) Syndrome𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 50-year-old woman with the acute onset of vertigo, dysarthria, dysphagia and dysphonia/hoarseness (nucleus ambiguus), ptosis and imbalance. Her examination localized to a left lateral medullary (Wallenberg) synd...Image/MovingImage
247 Saccadic Hypermetria and Ipsipulsion (Behind Closed Eyelids and with Vertical Saccades)𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 40-year-old woman who experienced oscillopsia and vertical diplopia, due to spontaneous torsional nystagmus and a skew deviation (right hypotropia), respectively. The symptom onset was 7 months prior to these vi...Image/MovingImage
248 Divergence Insufficiency in Cerebellar AtaxiaThis is a 65-yo woman with complaints of imbalance (progressive over years) and horizontal diplopia at distance. On her exam, there was a small symptomatic esotropia at distance, but only a small esophoria at near. There were no obvious abduction deficits, and the 6 prism diopter ET at distance was...Image/MovingImage
249 Trigeminal, Facial (with Aberrant Regeneration), and Vestibulocochlear Nerve Palsies Following Tumor ResectionThis is a 30-yo-woman who underwent resection of a right trigeminal schwannoma. Post-operatively, she was vertiginous with a clearly + head impulse test to the right (and spontaneous left-beating nystagmus), had lost hearing in the right ear, had no facial sensation on the right, and had a right low...Image/MovingImage
250 Lateral Pontine Stroke Involving the Superior Vestibular Nucleus Causing Spontaneous Upbeat-torsional Nystagmus𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: A 65-year-old man presented to the emergency department with spontaneous vertigo and unsteadiness, and had was noted to have spontaneous upbeat nystagmus (UBN), also with a torsional component (top poles beating toward th...Image/MovingImage
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