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226 Vestibular neuritis with a peripheral skew deviationThis is a 55-year-old hypertensive man who developed acute onset continuous vertigo and presented to the Emergency Department (ED) after several hours of symptoms. He was noted to have spontaneous nystagmus and had a normal brain MRI within the first 24 hours. The first portion of the video was rec...
227 Vibration and hyperventilation-induced nystagmus from vestibular schwannomaThis is a 50-yo-woman with imbalance, and with fixation removed on her examination (with Frenzel goggles), there was no spontaneous nystagmus. Using a handheld vibrator to vibrate the mastoids and vertex, there was a rightward slow phase and corrective leftward fast phase (left-beating nystagmus). V...Image/MovingImage
228 Vibration-induced nystagmus in a patient with vestibular neuritisThis is a 60-year-old man who experienced the sudden onset of vertigo, oscillopsia, imbalance, nausea and vomiting. He was seen in the emergency department within hours and had spontaneous right-beating (RBN) and torsional (top poles toward right ear) nystagmus that was unidirectional in all directi...
229 Video head impulse testingThe video head impulse test (vHIT) is a clinical assessment technique used to assess the function of the semicircular canals-the angular acceleration detectors-which initiate the vestibulo-ocular reflex (VOR). The HIT and vHIT are performed similarly (see assessment of VOR using HIT video LINK), alt...
230 Voluntary Ocular FlutterThis is a 45-yo-man with intermittent complaints of horizontal oscillopsia for 1 year. On examination, all classes of eye movements were normal, and neurologic examination was normal. MRI of the brain had been performed previously and was normal. During the exam while viewing any target close to his...Image/MovingImage
231 VOR (Slow and Fast)Slow vestibulo-ocular reflex (VOR): Since smooth pursuit and VOR systems are both active, if eye movements are choppy with this maneuver this implies deficits in both pursuit and the vestibular system as in CANVAS; Fast (HIT): Since smooth pursuit fails at high frequencies and high speeds, the VOR i...Image/MovingImage
232 VOR (Suppression)Deficits in pursuit and vestibulo-ocular reflex (VOR)S usually go together, except when the VOR is absent or markedly diminished in which case there is no VOR to suppress, so that VORS seems better than pursuit. This is an important clue that the VOR is diminished. Instructional ocular motor examina...Image/MovingImage
233 Wall-eyed bilateral INO in caudal midbrain lesionThis is a 30-yo-woman with the relatively acute onset of diplopia. There was a large angle exotropia, very subtle lag of the adducting saccades OD>OS, suggestive of bilateral INOs. This was best seen with rapid horizontal saccades, and a lesion involving bilateral MLFs in the caudal midbrain was dem...Image/MovingImage
234 Wallenberg syndrome in MS30-yo-woman with MS presenting with acute vertigo and vertical diplopia. Examination demonstrated several aspects of the Wallenberg syndrome (her acute demyelinating lesion was in the left lateral medulla): ipsilesional (left) ocular lateropulsion (hypermetric saccades to the left, hypo to the right...Image/MovingImage
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