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Title | Description | Subject |
226 |
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Pons: 6th and 7th Nerve Anatomy and the Central Segmental Tract | From this cross-section of the pons, the proximity of the 6th nucleus to the 7th nerve fascicles is apparent. This is the basis of the so-called facial colliculus syndrome, where an ipsilesional horizontal gaze palsy from a nuclear 6th lesion (usually related to stroke or demyelination) can be seen ... | Sixth Nerve Palsy; Inter Nuclear Ophthalmoplegia; INO; One-and-a-Half; Horizontal Gaze Palsy; OMS Pons; Facial Nerve; Oculopalatal |
227 |
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Pons: 6th, 7th, 8th, and Middle Cerebellar Peduncle Anatomy | From this cross-section of the pons, the proximity of the 7th and 8th fascicles can be appreciated, and a lateral inferior pontine syndrome (anterior inferior cerebellar artery territory), which could involve both of these fascicles, could cause acute prolonged vertigo accompanied by a + ipsilateral... | Sixth Nerve Palsy; OMS Pons; Facial Nerve; VOR Normal; VOR Abnormal |
228 |
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Pontine Hemorrhage Causing Oculopalatal Tremor and Multiple Cranial Neuropathies | This is a 45-yo-woman who had a dorsal pontine cavernoma that bled 2 years prior to this video. Symptoms included diplopia and oscillopsia. On examination, she had left>right facial palsies (upper and lower face from involvement of the nucleus/fascicle - i.e., lower motor neuron palsies) and sixth n... | Sixth Nerve Palsy; Pons; Pendular Nystagmus; Oculopalatal Tremor |
229 |
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Positional Downbeat Nystagmus Mimicking Anterior Canal BPPV | Although positional downbeat nystagmus (pDBN) can indicate the rare anterior canal variant of benign paroxysmal positional vertigo, central mimics are common causes of pDBN. pDBN may be seen in multiple system atrophy (MSA), or seen with posterior fossa lesions, with a common example being a stroke ... | Cerebellar; Jerk Nystagmus; Downbeat Nystagmus; Central Positional Nystagmus |
230 |
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Positional Nystagmus During an Attack of Vestibular Migraine | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: A 50-year-old woman presented to clinic after experiencing multiple episodes of hours-long vertigo attacks that were associated with headache, photophobia and phonophobia. She had a history of motion sickness and migraine... | Central Positional Nystagmus; Downbeat Nystagmus; Rotary Nystagmus; Jerk Nystagmus |
231 |
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Post-infectious Ocular Flutter and Myoclonus Syndrome | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 35-yo-woman presenting with oscillopsia following a viral illness. She described being easily startled, with "shakiness" of the head/neck and body. She had myoclonus and ocular flutter, with the latter evident w... | Flutter |
232 |
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Posterior Canal - BPPV: Epley and Semont Maneuvers | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: Epley/canalith repositioning maneuver (CRP) To treat right posterior canal (PC)-BPPV (each position maintained for at least 30 seconds or until nystagmus and/or vertigo cease): • First the patient is placed in the long-... | Benign Paroxysmal Positional Vertigo; BPPV; Posterior Canal; Epley Canalith Repositioning Maneuver - CRP; Semont Maneuver; Exam; Examination |
233 |
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Posterior Canal BPPV Pre- and Post-Epley Maneuver | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a patient with typical right posterior canal benign paroxysmal positional vertigo (BPPV), which was provoked by the Dix-Hallpike maneuver. When the patient was moved into the right Dix-Hallpike maneuver, after a b... | BPPV Posterior; BPPV Diagnosis; BPPV Treatment; Jerk Nystagmus; Vestibular Nystagmus |
234 |
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Posterior Canal BPPV Treated with Semont Maneuver | This is a patient with left posterior canal (PC) benign paroxysmal positional vertigo (BPPV), and upbeat-torsional (towards the left ear) nystagmus was provoked by left Dix-Hallpike maneuver and left side-lying maneuver. This video demonstrates treatment of her left PC BPPV with the Semont maneuver.... | BPPV Posterior; BPPV Diagnosis; BPPV Treatment; Jerk Nystagmus; Vestibular Nystagmus |
235 |
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Posterior Canal BPPV with Fixation and with Fixation Removed | This is a 60-yo-woman with positional vertigo. In the right Dix-Hallpike position with fixation removed, there was clear upbeat-torsional nystagmus (towards the lowermost right ear) which led to the diagnosis of right posterior canal BPPV. In right Dix-Hallpike with fixation there was mainly torsion... | Benign Paroxysmal Positional Vertigo; BPPV; Dix-Hallpike; Posterior Canal; Vestibular Nystagmus; Jerk Nystagmus |
236 |
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Pressure Testing for Superior Canal Dehiscence Syndrome | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: Superior semicircular canal dehiscence syndrome (SCDS) is caused by a third mobile window in the inner ear. This allows for transmission of sound or pressure to the superior canal. Tragal compression and/or glottic and ... | Valsalva; Superior Canal Dehiscence Syndrome |
237 |
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Prolonged Lid Twitch in Myasthenia Gravis | This 50-yo-woman with ocular MG demonstrated a spontaneous and particularly prolonged eyelid twitch. | Myasthenia Gravis |
238 |
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Provocative Maneuvers (Removal of Fixation, Vibration, Head-Shaking) to Accentuate Peripheral Vestibular Nystagmus) | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: With an acute destructive process like vestibular neuritis that causes significant unilateral vestibular loss, spontaneous nystagmus is always present. However, over days to months, spontaneous nystagmus should resolve co... | Headshaking Nystagmus |
239 |
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Pseudo-INOs in Myasthenia Gravis | This is a 55-yo-woman with an intermittent exotropia who had normal adduction OU, but clear lag of adducting saccades OD>OS with rapid horizontal saccades. This was much more apparent after repeat testing (ie, it was fatigable), and she wound up having ocular MG. | Myasthenia Gravis; INO; Abnormal Saccades |
240 |
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Pseudo-Spontaneous Nystagmus and Bow and Lean Test in Horizontal Canal BPPV | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻:This is a 70-year-old woman presenting to the Emergency Department with positional vertigo that was determined to be due to the apogeotropic variant of right horizontal canal (HC) benign paroxysmal positional vertigo (BPPV... | Benign Paroxysmal Positional Vertigo; BPPV; Horizontal Canal; Jerk Nystagmus; Vestibular Nystagmus; Head Shaking |
241 |
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Pseudonystagmus Due to Bilateral Vestibular Loss and Head Tremor | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 65-yo-woman with complaints of imbalance, dizziness, and horizontal oscillopsia. On exam, she had a high frequency, low amplitude (mainly horizontal) head tremor, and with ophthalmoscopy, the optic nerve was cle... | Abnormal VOR HIT |
242 |
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Range of Eye Movements and Evaluation for Nystagmus | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: Range: Assesses for motility deficit due to an ocular motor palsy, particularly if a posterior fossa localization is being considered; Nystagmus: Spontaneous nystagmus may or may not be noted and gaze-evoked nystagmus is ... | Exam; Nystagmus; Range of Eye Movements |
243 |
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Range of Motion (Ductions) | Range of motion (ductions): check the range of each individual eye (ductions) if there is diplopia or if a motility deficit is suspected. Instructing the patient to hold their head 20o to the right or to the left may provide a better view of the range of horizontal gaze, if there is diplopia or if a... | Range of Motion; Ductions |
244 |
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Rebound Nystagmus | This is a 50-yo-man who presented for dizziness and imbalance. His exam demonstrated choppy smooth pursuit and VOR suppression as well as mild gait ataxia. There was mild right-beating nystagmus in right gaze and left-beating nystagmus in left gaze without vertical gaze-evoked nystagmus. Occasionall... | Cerebellar; Jerk Nystagmus; Gaze Evoked Nystagmus; Rebound Nystagmus |
245 |
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Relationship Between Semicircular Canals and Extraocular Muscles | Figure 1: When stimulated, each of the 6 angular acceleration detecting semicircular canals (3 on the right and 3 on the left) responds with a conjugate eye movement, with the vector(s) indicated below. PC=posterior canal; HC=horizontal (also known as lateral) canal; AC=anterior (also known as super... | Extraocular Muscles |
246 |
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Relative Afferent Pupillary Defect in Compressive Optic Neuropathy Due to Meningioma | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 35-year-old woman with a compressive optic neuropathy OS due to a meningioma. She had normal acuity and color OD, with 20/40 acuity and dyschromatopsia OS. There was loss of visual field OS with a mainly tempora... | Optic Nerve Disease |
247 |
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Reversal of Vertical Nystagmus with Convergence in Anti-DPPX Encephalitis | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This 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, s... | Upbeat Nystagmus; Downbeat Nystagmus; Jerk Nystagmus; Gaze-Evoked Nystagmus |
248 |
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Rotary Chair Testing | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: Rotary chair testing includes rotation around a vertical axis, and evaluates the horizontal semicircular canal vestibulo-ocular reflex (VOR). The patient sits in a mechanized chair with the head secured in a neutral posi... | Normal VOR; Abnormal VOR; Vestibular Lab Testing; Rotary Chair |
249 |
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Saccades | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: The examiner should note: conjugacy (a lag of the adducting eye may be seen with an INO); accuracy (posterior fossa lesions commonly produce dysmetria (overshooting or undershooting); velocity (if slow, may suggest a lesi... | Saccades; Exam; Conjugacy; Abnormal Saccades |
250 |
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Saccades | Saccades: instruct the patient to make rapid movements of their eyes in each gaze direction, noting the speed, conjugacy, latency, and accuracy. First have the patient look between an eccentric target and the camera horizontally and vertically, making assessment of accuracy easier - e.g., overshooti... | Saccades |