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/
TO
| Title | Description | Subject | ||
|---|---|---|---|---|
| 26 |
 |
Bilateral INOs Due to Stroke | This is a 65-year-old man with multiple vascular risk factors who experienced the abrupt onset of diplopia 6 months prior to this video. MRI done within 24 hours of onset was unremarkable. Examination demonstrated subtle bilateral adduction lag with horizontal saccades. There was very mild abducting... | Abnormal Saccades; Abnormal Range |
| 27 |
 |
Bilateral INOs and Partial 3rd Nerve Palsies | This is a 45-year-old man with progressive ptosis and ophthalmoparesis. 10 years prior to presentation, he experienced diplopia and had a hyperintense lesion involving the medial longitudinal fasciculus (MLF) per report. Over time, he developed bilateral adduction paresis, ptosis and upgaze paresis ... | Abnormal Range; Third Subnuclear; INO; Mesencephalon |
| 28 |
 |
Bilateral Pseudo-abducens Palsies Due to Midbrain Stroke | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a man who suffered right>left midbrain strokes due to endocarditis complaining of ptosis and inability to move his eyes as well as hallucinations (peduncular hallucinosis). There was a presumed nuclear 3rd nerve p... | Bilateral Pseudo-abducens Palsies; Midbrain Stroke |
| 29 |
|
Bilateral Vestibular Loss With Gaze-Evoked Nystagmus and Saccadic Visually Enhanced VOR | This is 55-year-old man with the subacute onset of head movement-induced oscillopsia and dizziness. He had a history of psoriatic arthritis. He had not used medications known to be vestibulo-toxic such as gentamicin. ; Salient findings on his examination included 1) bilateral vestibular loss (BVL) d... | Jerk Nystagmus; Gaze-Evoked Nystagmus; Abnormal VOR-HIT; Eighth Nerve |
| 30 |
|
Bilateral riMLF Syndrome Causing Vertical Saccadic Palsy and Loss of Ipsitorsional Fast Phases | This is a 60-year-old man who developed fatigue and diabetes insipidus about 12 months prior to this video, and MRI demonstrated hypothalamic enhancement at that time. Nine months prior to this video, he gradually noticed that he was unable to look down. Work-up for ischemic, infectious, inflammator... | Midbrain OMS; Downgaze Palsy; Upgaze Palsy; Vertical Gaze Palsy; Abnormal Saccades; Normal Pursuit |
| 31 |
 |
Bilaterally Abnormal Head Impulse Test | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This video is an example of bilaterally abnormal head impulse test (HIT) due to bilateral vestibular loss (BVL). Typical symptoms in BVL: head movement-induced dizziness and jumping vision for years with visual jumping/b... | Abnormal VOR-HIT; Eighth Nerve |
| 32 |
 |
Brainstem Ocular Motor Machinery | Seen here is a sagittal view of the brainstem. The medulla has a significant role in gaze-holding, and the nucleus prepositus hypoglossi (NPH, along with the medial vestibular nucleus ) is the horizontal neural integrator. The abducens (6th) nucleus is located in the dorsal pons, and sends off the 6... | Medulla OMS; Pons OMS; Mesencephalon OMS; Dorsal Midbrain OMS |
| 33 |
 |
Bruns Nystagmus (During Video-Oculography) Due to Vestibular Schwannoma | A 25-year-old man with a history of right-sided hearing loss, headaches and imbalance was found to have a right vestibular schwannoma on MRI, and underwent a partial resection and radiotherapy. He denied symptoms of head movement dependent oscillopsia (i.e., suggestive of significant unilateral or b... | Jerk Nystagmus; Gaze-Evoked Nystagmus; Vestbular Nystagmus; Eighth Cranial Nerve; Vestibulocochlear Nerve; Cerebellar OMS |
| 34 |
 |
Bruns Nystagmus Due to a Cerebellopontine Angle Tumor | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 15-yo-girl who experienced headache and imbalance leading to an MRI which showed a left sided cerebellopontine angle (CPA) tumor. Because of involvement of the left brainstem/cerebellum (e.g., dysfunction of the... | Jerk Nystagmus; Gaze Evoked Nystagmus; Vestibular Nystagmus |
| 35 |
 |
Caloric Testing | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: Caloric testing is a peripheral vestibular test which takes advantage of the fact that the labyrinth is sensitive to temperature changes. Warm stimulation causes excitation of the semicircular canals while cold stimulatio... | Normal VOR; Abnormal VOR; Vestibular Lab Testing; Calorics |
| 36 |
 |
Cavernous Sinus Mass Causing Right 3rd and 4th Nerve Palsies | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: 25-yo-man who complained of diplopia and was initially found to have right 4th and 6th nerve palsies in the setting of a right cavernous sinus mass (subsequently diagnosed as Ewing's sarcoma). When seen in follow-up (this... | Third (Oculomotor) Nerve Palsy; ThirdSsubnuclear; Fourth (Trochlear) Nerve Palsy |
| 37 |
 |
Central (Nuclear) 3rd Nerve Palsies | Shown here are two patients with left sided midbrain pathology (hemorrhage and ischemia) which caused damage to the 3rd nucleus. Both of the patients have ipsilateral mydriasis, adduction, supra- and infraduction paresis. Ipsilateral>contralateral ptosis is also present, and localizes to the central... | Range of Eye Movements/Motility Abnormal; Third Nuclear; Upgaze Palsy; Downgaze Palsy; Mesencephalon; Jerk Nystagmus; Rotary Nystagmus |
| 38 |
 |
Central 4th Nerve Palsy with Contralateral Horner's Syndrome | This is a 60-yo-woman who presented with a complaint of diplopia. Examination demonstrated a left hypertropia that worsened in right and down gaze as well as in left head tilt, and a left 4th nerve palsy was diagnosed. There was also evidence of a mild motility deficit in down/medial gaze OS, consis... | Horner's; Fourth Nerve Palsy; Mesencephalon |
| 39 |
 |
Central Acute Vestibular Syndrome Due to Posterior Fossa Hemorrhage | This is a patient presenting with the acute vestibular syndrome (AVS, e.g., acute prolonged vertigo, spontaneous nystagmus) whose HINTS (Head Impulse, Nystagmus, Test of Skew) testing indicated a central etiology based on negative (normal) head impulse testing (HIT). Nystagmus was unidirectional and... | VOR HIT; Alignment; Jerk Nystagmus; Vestibular Nystagmus; Acute Vestibular |
| 40 |
 |
Central HINTS (With an Abnormal Head Impulse Sign) in the Acute Vestibular Syndrome Due to Lateral Pontine/Middle Cerebellar Peduncle Demyelination | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 30-year-old man presenting with vertigo, diplopia and mild left facial weakness (not seen in the video). On exam, there was right-beating nystagmus (RBN) in primary gaze that increased in right gaze (in accordan... | Abnormal Alignment; Vestibulocochlear; OMS Pons; Rotary Nystagmus; Vestibular Nystagmus; Acute Vestibular Nystagmus; Jerk Nystagmus; VOR HIT Abnormal |
| 41 |
|
Central Positional Vertigo and Nystagmus in a Posterior Fossa Tumor | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 30-year old woman who presented with positional vertigo and vomiting following a concussion related to a car accident 3 months prior. She was initially diagnosed with posterior canal (PC) benign paroxysmal posit... | Vestibular Nystagmus; Jerk Nystagmus; Gaze-Evoked Nystagmus; Central Positional Nystagmus; Cerebellar OMS; Downbeat Nystagmus; Upbeat Nystagmus |
| 42 |
 |
Central Vestibular Nystagmus in Anti-DPPX Encephalitis | This is a young woman who presented with oscillopsia due to spontaneous nystagmus in addition to gastrointestinal symptoms which led to the diagnosis of anti-DPP axis encephalitis. She was treated with rituximab, and experience gradual improvement over time. However, years after the onset, she con... | |
| 43 |
 |
Centripetal Nystagmus Example | A 68-year-old female reported a 2-year history of progressive gait imbalance, falls, dizziness and vertical oscillopsia. She described that dizziness and oscillopsia were worst when looking down. There was no family history of ataxia. Composite gaze with fixation was recorded with video-oculography ... | Gaze-evoked Nystagmus; Rebound Nystagmus; Centripetal Nystagmus; Cerebellar Degeneration |
| 44 |
 |
Cerebellar Ataxia, Neuropathy, & Vestibular Areflexia Syndrome (CANVAS): Impaired Visually-Enhanced VOR and Abnormal Head Impulse Testing | A 67 year old woman presented with 1 year of progressive numbness, gait instability, and oscillopsia when walking or with head movements. Examination showed excessive square-wave jerks, bilateral horizontal gaze-evoked nystagmus, impairment of the visually-enhanced vestibular ocular reflex (vVOR - s... | VOR Abnormal; HIT Abnormal; Jerk Nystagmus; Gaze Evoked Nystagmus; Square Wave Jerks |
| 45 |
 |
Cerebellar Degeneration with Downbeat Nystagmus Provoked by Convergence | Description: This is a 70-yo-woman with a progressive gait disorder, diagnosed with cerebellar ataxia. She displayed typical cerebellar ocular motor signs including gaze-evoked nystagmus, choppy pursuit and VOR suppression, and there was very subtle spontaneous downbeat nystagmus, best appreciated w... | Convergence Abnormal; Cerebellar Pathology; Jerk Nystagmus; Downbeat Nystagmus |
| 46 |
 |
Cerebellar Eye Signs in SCA8 | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 30-yo-man with a diagnosis of SCA 8 who had appendicular and gait ataxia in addition to choppy smooth pursuit and VORS, downbeat nystagmus, saccadic hypermetria, and gaze-evoked nystagmus with rebound nystagmus.... | Saccadic Dysmetria; Downbeat Nystagmus; Gaze-evoked Nystagmus; Vestibulo-ocular Reflex (VOR) Supression; Saccades |
| 47 |
 |
Change in Pendular Nystagmus from Oculopalatal Tremor over a Four-year Period | This is a patient who developed oculopalatal tremor months following a pontine hemorrhage. Although it is not shown here, she also has palatal tremor. In the first video which was taken 1 year after her hemorrhage, a vertical-torsional pendular nystagmus can be seen, that is mildly dissociated giv... | |
| 48 |
 |
Chiari Malformation Causing Downbeat Nystagmus in Lateral Gaze | This is a 20-yo-man who presented with oscillopsia in lateral gaze from downbeat nystagmus (DBN). In primary gaze, very subtle DBN was only noted with ophthalmoscopy, but in lateral gaze, prominent DBN was present. Other central ocular motor signs included gaze-evoked nystagmus (GEN) vertically, in ... | Jerk Nystagmus; Gaze Evoked Nystagmus; Downbeat Nystagmus |
| 49 |
|
Chronic Facial Nerve Palsy with Aberrant Regeneration | This is a 35-year-old woman who was diagnosed with right sided Bell's palsy six months prior. Contrast-enhanced MRI at that time was normal. This video demonstrates the phenomenon of aberrant regeneration (synkinesia) of the facial nerve. Due to aberrant regeneration, at rest the right palpebral fi... | Facial Nerve |
| 50 |
 |
Chronic Progressive External Ophthalmoplegia (CPEO) and Cerebellar Signs | This is a 60-yo-woman who initially presented with imbalance and ophthalmoparesis. Initially, there was mild horizontal gaze limitation with mild gaze-evoked nystagmus and slow saccades, and over the years, gait ataxia and dysarthria (mainly a scanning quality to her speech) developed, and her ophth... | Abnormal Saccades; Abnormal Range; Horizontal Gaze Palsy; Gaze Evoked Nystagmus |