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51 Duane's syndrome type 3This is a 40-yo-woman seen in neurology clinic for a complaint unrelated to her eyes. On exam, there was impaired adduction and abduction OS. In adduction, there was narrowing of the palpebral fissure OS, a result of her globe retraction due to co-contraction of the medial and lateral rectus muscles...Duane's syndrome
52 Dynamic visual acuityAfter assessing static binocular visual acuity, dynamic visual acuity (DVA) is determined by repeating the test during horizontal and vertical head shaking at 2-3 Hz. Dynamic visual acuity is most important to test when bilateral vestibular loss is suspected. A loss of at least 4 lines is typical ...Dynamic Visual Acuity
53 ENG, VNG, & VOGElectronystagmography (ENG), and videonystagmography (VNG) or videooculography (VOG) are a collection of tests of eye movements that are performed either using surface electrodes around the eye (ENG) or with video goggles (VNG, VOG) (Figure 1). For all clinical intents and purposes, VNG and VOG ar...Vestibular lab testing, ENG, VNG, & VOG
54 Elliptical Pendular Nystagmus in MSThis is a 40-yo-woman with MS and bilateral optic nerve disease who presented with a year's long history of oscillopsia, which was related to elliptical pendular nystagmus. The appearance of elliptical nystagmus is the result of out of phase horizontal and vertical components. She had a variety of p...Pendular Nystagmus, Multiple Sclerosis
55 Enhanced ptosis in Myasthenia GravisThis is a 20-yo-woman who presented with generalized weakness, ptosis and ophthalmoplegia. She had severe ptosis OU at baseline, but when one eyelid was manually elevated, there was marked enhanced ptosis of the opposite eyelid. This was in accordance with Hering's law of equal innervation of the le...Myasthenia Gravis
56 Evaluation of ConvergenceThe assessment of convergence includes measuring alignment at near versus distance (see video, https://collections.lib.utah.edu/details?id=187677), near point of convergence and convergence amplitude. Near point of convergence is assessed by bringing a fixation target toward the bridge of the patie...Normal Convergence
57 Evaluation of auditory function using Rinne and Weber testsThe Rinne test is an assessment of auditory thresholds to air and bone conduction of sound. The Weber test is a comparison of bone conducted sound of either ear. Conductive hearing loss results in a loss of air conducted greater than bone conducted sound, whereas sensorineural hearing loss results...Auditory Testing
58 Examples of patients with saccadic intrusions (square wave jerks)Seen here are patients with saccadic intrusions that do have an intersaccadic interval. Square wave jerks are commonly seen in degenerative conditions, mainly involving the posterior fossa (e.g., cerebellar degeneration) and basal ganglia (e.g., progressive supranuclear palsy).Square Wave Jerks
59 Eye closure and oculopalatal tremorThis patient suffered a traumatic brain injury with brainstem injury resulting in damage to Mollaret's triangle and palatal tremor. Inferior olivary hypertrophy was noted on her MRI, although no vertical and/or torsional pendular nystagmus was present even when observing closely with the ophthalmosc...Pendular Nystagmus; Oculopalatal Tremor
60 Eye signs in infantile esotropia - latent nystagmus and inferior oblique overactionThis is a 25-yo-man with a history of amblyopia and intermittent eye crossing. On exam, he had a comitant 25 prism diopter esotropia, and other features of infantile (or congenital) esotropia including: latent nystagmus (right-beating nystagmus with occlusion of the left eye and left-beating nystagm...Jerk Nystagmus, Latent Nystagmus, Abnormal Range, Assessing Abnormal Alignment
61 Eyelid anatomySeen here are the major muscles of eyelid opening and closure. The levator palpebrae, which is innervated by the oculomotor nerve, inserts on the tarsus via the levator aponeurosis and directly on the skin of the upper eyelid. The superior tarsal muscle (also known as Muller's muscle, which is inner...Figures
62 Eyelid retraction, pseudoabducens and upgaze palsy due to a mesodiencephalic hemorrhageThis is a 70-yo-man who suffered a right midline thalamic/rostral midbrain hemorrhagic stroke causing a pretectal (Parinaud's) syndrome. There was prominent eyelid retraction (Collier's sign), a left pseudo-abducens, and upgaze palsy with convergence retraction nystagmus. There was no light-near dis...OMS Mesenecephalon, Convergence Reaction Nystagmus, Upgaze Palsy, Abnormal Range, Sixth Nerve Palsy, Vertical Gaze Palsy, Eyelid Retraction, OMS Dorsal Midbrain
63 Gaze-evoked and centripetal nystagmus in Creutzfeldt-Jakob diseaseThis is a 65-year-old woman who experienced a progressive cerebellopathy over several months. Initially, she presented with mild gait imbalance and positional vertigo, and there was only apogeotropic positional nystagmus (more pronounced in supine roll test compared to Dix-Hallpike) with a very slig...Jerk Nystagmus, Gaze-Evoked Nystagmus, Rebound Nystagmus
64 Gaze-evoked and rebound nystagmus in a cerebellar syndrome30-yo-man with the subacute onset of a cerebellar syndrome. After extensive evaluation and progression, it was thought that this represented an autoimmune process and there was some improvement with immunosuppression. He had a variety of cerebellar ocular motor findings, including gaze-evoked nystag...Jerk nystagmus; End-gaze nystagmus; Gaze-evoked nystagmus; Rebound nystagmus; Cerebellar pathology
65 HINTS exam and saccadic dysmetria in lateral medullary strokeThis is a 50-year-old who experienced the abrupt onset of prolonged vertigo following chiropractic therapy 2 months prior. Initial work-up included an MRI and MR angiogram - MR-diffusion weighted imaging showed an acute left lateral medullary stroke and left vertebral artery occlusion, which was tho...Abnormal Saccades, Acute Vestibular Syndrome, Jerk Nystagmus, Vestibular Nystagmus, Normal VOR, Skew Deviation, OMS Medulla
66 Head-Shaking NystagmusHead-shaking nystagmus: With a peripheral lesion, similar to vibration, transiently accentuates vestibular asymmetry when baseline VOR function is asymmetric, central patterns are well described and have localizing value (e.g., causing vertical nystagmus after horizontal head-shaking, horizontal nys...Nystagmus, Head-shaking nystagmus, Exam
67 Head-Shaking-Induced Nystagmus Following Ramsay Hunt VestibulopathyThis is a 50-year-old man who experienced the abrupt onset of imbalance, dizziness and left-sided hearing loss 4 months prior to this examination. He was found to have herpetic vesicles in the left external auditory canal and diagnosed with Ramsay Hunt syndrome. On exam (4 months after the onset), t...Vestibular Nystagmus; Head-Shaking; Jerk Nystagmus; Vestibularcochlear; Acute Vestibular Syndrome
68 Head-shaking nystagmus - a "central" patternEvaluating for nystagmus provoked by head-shaking, so-called head-shaking nystagmus (HSN), should be performed in all patients with complaints of dizziness or vertigo, regardless of the chronicity. The maneuver is performed by passively moving the head horizontally (can also be performed vertically)...Abnormal Head Shaking, Jerk Nystagmus, Vestibular Nystagmus
69 Horizontal Canal - BPPV: BBQ Roll to treat the right sideTo treat right horizontal canal (HC)-BPPV (each position maintained for at least 30 seconds or until nystagmus and/or vertigo cease): • First the patient is placed in the long-sitting position • Then in a supine position with the head elevated 30 degrees • Then the patient's head (or whole bod...Benign Paroxysmal Positional Vertigo; BPPV; Horizontal Canal; Lempert 360- (Barbeque) degree roll maneuver; Exam; Examination
70 Horizontal Canal - BPPV: Gufoni for right apogeotropicTo treat the right apogeotropic (beating towards the sky with right ear down and with left ear down - e.g., left beating nystagmus with right supine roll test or with right ear down; right beating nystagmus with left supine roll test or with left ear down) horizontal canal (HC) variant: • The pati...Benign Paroxysmal Positional Vertigo; BPPV; Horizontal Canal; Ageotrophic Gufoni Maneuver; Exam; Examination
71 Horizontal Gaze Palsy, Facial Nerve Palsy, and Nystagmus Due to Dorsal Pontine IschemiaPresented here are two patients with horizontal gaze and facial palsies due to stroke. The first patient is a 60-year-old man who presented with double vision and hemiparesis due to a right dorsal pontine ischemic stroke. His exam was significant for a right horizontal gaze palsy due to right 6th nu...One and half syndome; Horizontal gaze palsy; Pons; Jerk nystagmus; Upbeat nystagmus; Gaze evoked nystagmus; Facial nerve palsy; Internuclear ophthalmoplegia
72 Horner's syndrome with anhidrosisThis is a patient with the onset of ptosis OD years prior, with clear evidence of a Horner's syndrome. Imaging of the oculosympathetic tract was unrevealing. The patient also mentioned that with exercise, the left side of her face will sweat and turn red while the right side wouldn't. She took a pic...Horner's Syndrome
73 Hyperventilation-induced downbeat nystagmus in a cerebellar disorderThis is a 45-year-old woman with a chronic progressive cerebellopathy of unclear etiology (worsening over at least 10 years) characterized by gait and limb ataxia, gaze-evoked nystagmus, saccadic pursuit and vestibulo-ocular reflex suppression, an esotropia greater at distance, along with very mild ...Hyperventilation; Jerk Nystagmus; Downbeat Nystagmus; Downbeat Nystagmus; Cerebellar Pathology
74 INO in multiple sclerosisDescription: This video includes 3 patients each with a known history of MS found to have unilateral or bilateral INOs on their exam. In the first 2 patients, the INOs are relatively subtle with normal adduction. However, with rapid horizontal saccades, an adduction lag is apparent which is suggesti...Internuclear Ophthalmoplegia, Abnormal Saccades, Gaze Evoked Nystagmus
75 INOs in strokeThis video shows 3 patients with vascular risk factors who suffered strokes of the MLF resulting in unilateral INO in each case. In the second case, INO was diagnosed status post cardiac catherization and MRI was found to be normal. In the third case, the patient had a clear left medial rectus palsy...Internuclear Ophthalmoplegia, Abnormal Saccades, Gaze Evoked Nystagmus, Abducting Nystagmus
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