NOVEL - Daniel Gold Collection
 
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76 Eye Closure and Oculopalatal Tremor𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This 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; Oculopalatal Tremor
77 Eye Handbook App for OKNOptokinetic nystagmus (OKN): one way this can be examined virtually is using a smartphone application (e.g. Eye Handbook © app used in this video) or optokinetic tape/flag/drum held in front of the examiner's camera. The optokinetic stimulus should occupy the full screen of the patient's device (ea...Eye Handbook App for OKN
78 Eye Signs in Infantile Esotropia - Latent Nystagmus and Inferior Oblique Overaction𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This 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 (...Jerk Nystagmus; Latent Nystagmus; Abnormal Range; Assessing Abnormal Alignment
79 Eyelid NystagmusLid nystagmus is a rhythmic eyelid movement commonly seen as an epiphenomenon of vertical nystagmus (typically upbeating, as in this case) due to a shared central pathway controlling elevation of the lid and supraduction. There can be isolated lid nystagmus if there is accompanying impairment of su...Nystagmus; Eyelid Nystagmus
80 Five Common Ocular Motor Signs in Cerebellar Disorders - Saccadic Hypermetria, Saccadic Pursuit & VOR Suppression, Gaze-evoked & Rebound Nystagmus(1) Saccadic hypermetria - an overshoot of the visual target (2) Saccadic smooth pursuit - due to impaired pursuit and low gain, saccades are needed to keep up with the visual target. This gives it a ‘choppy' appearance. (3) Saccadic vestibulo-ocular reflex (VOR) suppression - another...Abnormal Saccades; Abnormal Pursuit; Abnormal Vestibulo-ocular Reflex (VOR) Suppression; Jerk Nystagmus; Gaze-evoked Nystagmus; Rebound Nystagmus; Cerebellar Oms
81 Fixation and Gaze HoldingFixation and gaze-holding: assess for nystagmus or saccadic intrusions by observing the eyes in primary position. Then instruct the patient to look in each position of gaze, and to hold that position to assess for gaze-evoked nystagmus. In doing so, motility can also be evaluated with both eyes view...Fixation and Gaze Holding
82 Gaze-Evoked Nystagmus & Slow Saccades Due to Anti-GAD Antibodies in a Patient with Stiff Person SyndromeThis is a 70-year-old woman with a several year long history of imbalance and stiffness. Exam demonstrated axial and lower extremity stiffness, and ocular motor exam demonstrated gaze-evoked nystagmus (e.g., right-beating in right gaze, left-beating in left gaze, up-beating in up gaze), and mild to ...Jerk Nystagmus; Gaze-Evoked Nystagmus; Abnormal Saccades
83 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
84 Gaze-Evoked, Rebound, and Centripetal Nystagmus in Cerebellar DegenerationA 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
85 Gaze-evoked and Rebound Nystagmus in a Cerebellar Syndrome𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: 30-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 ...Jerk Nystagmus; End-gaze Nystagmus; Gaze-evoked Nystagmus; Rebound Nystagmus; Cerebellar Pathology
86 HINTS Exam and Saccadic Dysmetria in Lateral Medullary Stroke𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This 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 l...Abnormal Saccades; Acute Vestibular Syndrome; Jerk Nystagmus; Vestibular Nystagmus; Normal VOR; Skew Deviation; OMS Medulla
87 Head Movement Independent ('Sitting') Oscillopsia - A Common Symptom of Nystagmus and Saccadic Intrusions/Oscillations𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This video is an example of what a patient with spontaneous nystagmus or saccadic intrusions/oscillations experiences visually during the abnormal eye movements - i.e., oscillopsia (illusion of movement of the stationary ...
88 Head-Shaking (2-3 Hz)Head-shaking: instruct the patient to close their eyes and perform active rapid head-shaking at 2-3 Hz for ~15 secs. If a unilateral vestibulopathy is present, head-shaking-induced (contralesional) nystagmus is often provoked, with the slow phase toward the affected ear. With central lesions, the ny...Head-Shaking (2-3 Hz)
89 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
90 Head-Shaking Nystagmus - A 'Central' Pattern𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: Evaluating 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 perform...Abnormal Head Shaking; Jerk Nystagmus; Vestibular Nystagmus
91 Head-Shaking-Induced Nystagmus Following Ramsay Hunt Vestibulopathy𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This 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...Vestibular Nystagmus; Head-Shaking; Jerk Nystagmus; Vestibularcochlear; Acute Vestibular Syndrome
92 Hemifacial SpasmThis is a 45-year-old man with intermittent left facial twitching and eyelid closure for the last 6 months. With observation, spontaneous left facial spasms were seen involving the orbicularis oculi and oris muscles. With voluntary contraction of left facial muscles, with smiling for instance, there...Facial Nerve
93 Horizontal Canal - BPPV: BBQ Roll to Treat the Right Side𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: To 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 posit...Benign Paroxysmal Positional Vertigo; BPPV; Horizontal Canal; Lempert 360- (Barbeque) Degree Roll Maneuver; Exam; Examination
94 Horizontal Canal - BPPV: Gufoni for Right Apogeotropic𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: To 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 supi...Benign Paroxysmal Positional Vertigo; BPPV; Horizontal Canal; Ageotrophic Gufoni Maneuver; Exam; Examination
95 Horizontal Gaze Palsy, Facial Nerve Palsy, and Nystagmus Due to Dorsal Pontine Ischemia𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: Presented 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....One-and-a-Half Syndome; Horizontal Gaze Palsy; Pons; Jerk Nystagmus; Upbeat Nystagmus; Gaze Evoked Nystagmus; Facial Nerve Palsy; Internuclear Ophthalmoplegia
96 Horner's Syndrome with Anhidrosis𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This 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...Horner's Syndrome
97 How to Measure Ocular Alignment VirtuallyOcular alignment: the alternate cover test can be performed by instructing the patient to hold their head steady, fix their eyes on the camera (or a more distant target - the closer the fixation target, the more of an exodeviation the examiner will see), and use their cell phone (or a spoon) to occl...Ocular Alignment
98 HyperventilationHyperventilation: instruct the patient to breathe rapidly in and out of their mouth for 40-60 seconds. Alkalosis and changes in ionized calcium may improve conduction through an affected segment of 8th cranial nerve due to vestibular schwannoma (https://collections.lib.utah.edu/details?id=1213447) o...Hyperventilation
99 Hyperventilation-Induced Downbeat Nystagmus in a Cerebellar Disorder𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This 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-ocu...Hyperventilation; Jerk Nystagmus; Downbeat Nystagmus; Downbeat Nystagmus; Cerebellar Pathology
100 INOs in Stroke𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This 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...Internuclear Ophthalmoplegia; Abnormal Saccades; Gaze Evoked Nystagmus; Abducting Nystagmus
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