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TitleDescriptionType
226 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...
227 Dix-Hallpike maneuver in posterior BPPV with reversal of nystagmus on sitting upThis 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 brief latency, upbeat-torsional (towards the lowermost or affected [right] ear) nys...
228 Ocular motor signs in progressive supranuclear palsy (PSP)This is a 65-yo-woman complaining of imbalance and double vision. She had significant convergence insufficiency (and would close her right eye with near viewing), providing an explanation for her diplopia. Convergence insufficiency is very common with parkinsonism. She had bradykinesia and rigidity,...Image/MovingImage
229 Vertical semicircular canal pathwaysAnterior Canal Pathway Afferents that originate in the anterior canals (AC) of the peripheral labyrinth first synapse in the ipsilateral vestibular nucleus. Three pathways exist: 1) medial longitudinal fasciculus (MLF) - right AC afferents to right medial vestibular nucleus (MVN), decussate and asc...
230 Reversal of vertical nystagmus with convergence in anti-DPPX encephalitisThis is a man who initially presented with spontaneous upbeat and torsional nystagmus, which led to the diagnosis of anti-DPPX encephalitis (for further details on this patient's course and for a video of his nystagmus, see reference 1). Over 6-12 months, his spontaneous (mainly) upbeat nystagmus (U...
231 Lateral pontine stroke involving the superior vestibular nucleus causing spontaneous upbeat-torsional nystagmusA 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 the right ear) that was most noticeable in right and up gaze. General neurologic ...Image/MovingImage
232 The most common audiovestibular laboratory tests, and the specific conditions in which they may assist in making or supporting the diagnosisVN = vestibular neuritis; VM = vestibular migraine; VP = vestibular paroxysmia; vHIT = video head impulse test; VNG = video-nystagmography; ENG = electronystagmography; VOG = video-oculography; VEMPs = vestibular evoked myogenic potentials; SCDS = superior canal dehiscence syndrome; BPPV = benign pa...
233 The most common vestibular conditions categorized by timing and triggers, with specific ocular motor and vestibular features that should be sought for eachHINTS+ = Head Impulse, Nystagmus, Test of Skew, ‘Plus' bedside assessment of auditory function; HIT = head impulse test; NP = nerve palsy; BPPV = benign paroxysmal positional vertigo; SCDS = superior canal dehiscence syndrome; BVL = bilateral vestibular loss; PPPD = persistent postural perceptual ...
234 Hyperventilation-induced downbeat nystagmus in a cerebellar disorderThis is a 45-year-old woman with a chronic progressive cerebellopathy of unclear etiology (worsening over at least 10 years) characterized by gait and limb ataxia, gaze-evoked nystagmus, saccadic pursuit and vestibulo-ocular reflex suppression, an esotropia greater at distance, along with very mild ...
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