A collection of videos relating to the diagnosis and treatment of eye movement disorders. This collection includes many demonstrations of examination techniques.
Dan Gold, D.O., Associate Professor of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, Emergency Medicine, and Medicine, The Johns Hopkins School of Medicine.
A collection of videos relating to the diagnosis and treatment of eye movement disorders.
NOVEL: https://novel.utah.edu/
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| Title | Description | Type | ||
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Medullary Structures Relevant to the Ocular Motor and Vestibular Consequences of Lateral Medullary (Wallenberg) Syndrome | This is an axial section of the medulla showing the structures that, when damaged, are responsible for the vestibular and ocular motor features of the lateral medullary or Wallenberg syndrome. The nucleus prepositus hypoglossi (NPH) and medial vestibular nucleus (MVN) complex is important for horizo... | Image |
| 27 |
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Saccadic Pathways in the Brainstem and Cerebellum & Mechanism for Saccadic Dysmetria in Wallenberg Syndrome - Abnormal Function of the Brainstem/Cerebellar Saccadic Pathways with a Left Wallenberg Syndrome | The end result of a lesion involving the climbing fibers within the left lateral medulla is deficient rightward saccades (contralesional hypometric saccades), and over-active leftward saccades (ipsilesional hypermetric saccades), and ipsilesional ocular lateropulsion given this baseline imbalance. M... | Image |
| 28 |
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The Utriculo-Ocular Motor Pathways - Physiologic and Pathologic Ocular Tilt Reaction: OTR Diagram Pathologic EOMs Labelled (Figure 3) | A skew deviation is a non-paralytic vertical ocular misalignment that is due to imbalance in the utriculo-ocular motor pathways. While vestibular jerk nystagmus is a consequence of static semicircular canal pathway imbalance (e.g., left-beating nystagmus due to acute right vestibular hypofunction fr... | Image |
| 29 |
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The Utriculo-Ocular Motor Pathways - Physiologic and Pathologic Ocular Tilt Reaction: Pathologic OTR (Figure 2) | A skew deviation is a non-paralytic vertical ocular misalignment that is due to imbalance in the utriculo-ocular motor pathways. While vestibular jerk nystagmus is a consequence of static semicircular canal pathway imbalance (e.g., left-beating nystagmus due to acute right vestibular hypofunction fr... | Image |
| 30 |
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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... | Image |
| 31 |
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Central Anatomy of the Third Nerve | Seen here is an axial section of the midbrain at the level of the superior colliculus. The paired nuclei are located ventral to the periaqueductal grey, and the midline central caudal nucleus (CCN) is located between the right and left nuclei. The CCN sends projections to bilateral levator palpebrae... | Image |
| 32 |
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Figure 17: Bony Structures Relevant to the Orbit | The frontal, sphenoid, maxillary, ethmoid, and lacrimal bones make up the orbit. Structures passing through the optic canal include the optic nerve, oculosympathetic tract and ophthalmic artery. Structures passing through the superior orbital fissure include the superior ophthalmic vein, cranial ner... | Image |
| 33 |
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Figure 1: Oculosympathetic Pathway for Pupillary Dilation | The oculosympathetic tract is an uncrossed pathway that begins in the hypothalamus, with fibers descending in the brainstem (1st order, commonly affected in a lateral medullary syndrome), synapsing in the lower cervical/upper thoracic spinal cord (interomediolateral cell columns of C8-T2, also refer... | Image |
| 34 |
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Figure 24: Typical Visual Field Defects Associated with Discrete Lesions Along the Visual Pathways | Specific monocular or binocular visual field defects can be highly localizing when the neuroanatomy of the visual pathways is understood. The temporal visual field corresponds to the nasal retina, while the nasal visual field corresponds to the temporal retina. 1) Left optic nerve lesion - while an ... | Image |
| 35 |
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Figure 2: Parasympathetic Pathway for Pupillary Constriction | A bright light is shone in one eye, light enters the pupil and hyperpolarizes retinal photoreceptors which activates retinal ganglion cells. These signals propagate along the optic nerves, chiasm, optic tracts, and fibers responsible for the light reflex then synapse in the dorsal midbrain (prior to... | Image |
| 36 |
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Figure 46: The Course of the 6th (VI) Nerve | The sixth nucleus is located dorsally, adjacent to the 4th ventricle, in the lower pons. The genu of the facial (7th) nerve wraps around the 6th nucleus, creating the facial colliculus, which bulges into the 4th ventricle. After the 6th nerve leaves the pons, it follows a vertical course along the c... | Image |
| 37 |
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Figure 50: Anatomy and Physiology of the Saccadic Pathways | When a saccade is desired (or reflexively triggered), signals project from the saccade-related cortical eye fields to the superior colliculus, which serves to integrate and relay commands to the saccade generating brainstem circuitry. The inferior cerebellar peduncle (ICP) carries climbing fibers to... | Image |
| 38 |
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Figure 51: Lateral Medullary Lesion Causing Saccadic Dysmetria | A lesion of the left lateral medulla and inferior cerebellar peduncle (ICP) will cause decreased climbing fiber inhibition of the left dorsal vermis causing simple-spike (inhibitory) discharge of Purkinje cells to increase. Increased Purkinje cell firing leads to increased inhibition of the ipsilate... | Image |
| 39 |
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Figure 51: Lateral Medullary Lesion Causing Saccadic Dysmetria (Supplement) | Image | |
| 40 |
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Figure 51: Lateral Medullary Lesion Causing Saccadic Dysmetria (Supplement) | Image | |
| 41 |
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Figure 53: Vascular Distribution and Anatomy Relevant to the Lateral Medullary (Wallenberg) Syndrome | This axial section of the medulla highlights those structures that, when damaged, are responsible for the vestibular and ocular motor features of the Wallenberg syndrome. The nucleus prepositus hypoglossi (NPH) and medial vestibular nucleus (MVN) complex is important for horizontal gaze-holding (neu... | Image |
| 42 |
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Figure 53: Vascular Distribution and Anatomy Relevant to the Lateral Medullary (Wallenberg) Syndrome (Supplement) | Image | |
| 43 |
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Figure 53: Vascular Distribution and Anatomy Relevant to the Lateral Medullary (Wallenberg) Syndrome (Supplement) | Image | |
| 44 |
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Figure 64: The Course of the 3rd (III) Nerve | The 3rd nucleus lies at the ventral border of the periaqueductal gray matter, at the level of the superior colliculus. In between the two nuclei is the midline central caudal nucleus (CCN), which innervates bilateral levator palpebrae muscles (explaining how a unilateral nuclear 3rd can cause bilate... | Image |
| 45 |
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Figure 64: The Course of the 3rd (III) Nerve (Supplement) | Image | |
| 46 |
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Figure 65: Vascular Distribution and Anatomy (Including 3rd Nerve) of the Rostral Midbrain | In this axial section of the midbrain at the level of the superior colliculus, the paired 3rd nuclei are located ventral to the periaqueductal grey, and the midline central caudal nucleus (CCN) is located in between. The fascicles that exit the IIIrd nuclei carry the fibers destined to innervate the... | Image |
| 47 |
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Figure 65: Vascular Distribution and Anatomy (Including 3rd Nerve) of the Rostral Midbrain (Supplement) | Image | |
| 48 |
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Figure 65: Vascular Distribution and Anatomy (Including 3rd Nerve) of the Rostral Midbrain (Supplement) | Image | |
| 49 |
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Figure 68: The Course of the 4th (IV) Nerve | The 4th nucleus lies at the ventral border of the periaqueductal gray matter, at the level of the inferior colliculus. The fascicles exit the nucleus dorsally and decussate at the anterior medullary velum (anterior floor of the fourth ventricle), and then exit the brainstem dorsally. The peripheral ... | Image |
| 50 |
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Figure 68: The Course of the 4th (IV) Nerve (Supplement) | Image |