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226 Vestibular neuritis with + head impulse test and unidirectional nystagmus-Figure 1Vestibular neuritis is the most common cause of the acute vestibular syndrome, which is characterized by continuous vertigo and spontaneous nystagmus lasting days. It may be mimicked by central causes, including stroke, but in the hands of subspecialists, the HINTS+ (Head Impulse, Nystagmus, Test of...Jerk Nystagmus, Acute Vestibular, Vestibular Nystagmus
227 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...Abnormal VOR, Abnormal Alignment, Eighth Nerve, Skew Deviation, Lateropulsion, Jerk Nystagmus, Vestibular Nystagmus, Acute Vestibular Syndrome
228 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...Jerk Nystagmus, Vestibular Nystagmus, Hyperventilation
229 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...Jerk Nystagmus; Vestibular Nystagmus; Eighth Cranial Nerve; Acute Vestibular Syndrome
230 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...Normal VOR, Abnormal VOR, Vestibular Lab Testing, Video Head Impulse Testing
231 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...Abnormal Convergence; Flutter; Voluntary Nystagmus; Voluntary ocular flutter
232 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...INO, Abnormal Saccades, Jerk Nystagmus, Gaze Evoked Nystagmus
233 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...Vestibulo-ocular reflex; Head impulse testing; Abnormal alignment; Lateropulsion; Wallenberg syndrome; Medulla; Vestibular nystagmus; Skew Deviation
234 riMLF Syndrome from Artery of Percheron StrokeThis is a 65-yo-man who suffered the abrupt onset of loss of consciousness followed by difficulty looking down. MRI showed bilateral rostral midbrain strokes in the distribution of the artery of Percheron. He could not initiate downward saccades and had fair upward saccades. However, downward vestib...Saccades abnormal; Vestibulo-ocular reflex and head impulse testing normal; Pursuit normal; Vertical gaze palsy; Downgaze palsy; Mesencephalon
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