NOVEL - Daniel Gold Collection
 
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76 Saccadic Dysmetria and Ocular Lateropulsion in Lateral Medullary Stroke𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 30-yo-man who suffered a right lateral medullary stroke. Examination showed saccadic hypermetria to the right (ipsilesional), hypometria to the left (contralesional)and rightward ocular lateropulsion (ipsilesion...Image/MovingImage
77 Testing for Adduction Lag in Partial INO Using an Optokinetic StimulusIn this patient we demonstrate the use of an optokinetic stimulus to elicit an internuclear ophthalmoplegia (INO). Occasionally adduction appears to be normal with an INO, and an adduction lag with horizontal saccades should be sought as a confirmatory sign. Optokinetic tape is an easy way to assess...Image/MovingImage
78 Acute Vestibular Syndrome with Ocular Tilt Reaction Due to Bacterial LabyrinthitisThis is a patient who initially presented with the acute vestibular syndrome (AVS, e.g., acute prolonged vertigo, spontaneous nystagmus) and right sided hearing loss, and was diagnosed with bacterial labyrinthritis. Her HINTS (Head Impulse, Nystagmus, Test of Skew) testing indicated a central etiolo...Image/MovingImage
79 Cerebellar Ataxia, Neuropathy, & Vestibular Areflexia Syndrome (CANVAS): Impaired Visually-Enhanced VOR and Abnormal Head Impulse TestingA 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...Image/MovingImage
80 Pseudonystagmus Due to Bilateral Vestibular Loss and Head Tremor𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 65-yo-woman with complaints of imbalance, dizziness, and horizontal oscillopsia. On exam, she had a high frequency, low amplitude (mainly horizontal) head tremor, and with ophthalmoscopy, the optic nerve was cle...Image/MovingImage
81 The Episodic Vestibular SyndromeThis is a 55-year-old man with 6 months of episodic vertigo without clear triggers/provocative factors, with each of his 3 previous episodes lasting less than 5 minutes. While in the clinic, he had one of his typical vertigo attacks. There was initially 30 seconds of right-beating-torsional nystagmu...Image/MovingImage
82 Mild 6th Nerve Palsy Due to Pontine StrokeThis is a 70-year-old woman with HTN and diabetes who presented with horizontal diplopia for several weeks, worse in right gaze. There was a very subtle abduction paresis OD with full motility elsewhere. With cover-uncover testing, there was a small esotropia in right gaze (esodeviation seen with al...Image/MovingImage
83 Oscillopsia and Bilateral Vestibular Loss with Gentamicin OtotoxicityPatients with bilateral vestibular loss commonly experience oscillopsia with head movements, or an inability to stabilize retinal images with subsequent bouncing or jumping of the environment due to loss of vestibular function. This causes significant blurring of vision and disorientation, dizziness...Image/MovingImage
84 Oscillopsia: A Common Symptom of Bilateral Vestibular Loss𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This video is an example of what a patient with bilateral vestibular loss experiences while walking. Without a VOR, there is no mechanism to ensure retinal stability of the world with each head movement, and oscillopsia (...Image/MovingImage
85 Pendular Nystagmus and Ocular Motor Signs in MS𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 30-year-old man with a 15 year history of multiple sclerosis. For the last 12 months, he experienced horizontal oscillopsia. On examination, there were ocular motor abnormalities including gaze-evoked nystagmus,...Image/MovingImage
86 Upbeat and Downbeat Nystagmus Due to Anti-VGCC AntibodiesSeen here are two patients who presented with imbalance and vertical oscillopsia, the first with upbeat nystagmus, and the second with downbeat nystagmus. Both patients were found to have voltage-gated calcium channel antibodies in serum without evidence of systemic malignancy. The UBN patient had m...Image/MovingImage
87 Using Video Head Impulse Testing to Unmask Covert Saccades in Compensated Vestibular VeuritisThis is a 30-year-old woman who experienced the acute vestibular syndrome (prolonged vertigo for >24 hours, nausea, unsteadiness, spontaneous nystagmus, head motion intolerance) and was diagnosed with vestibular neuritis. This diagnosis was based on a positive head impulse test to the left (see Figu...Image/MovingImage
88 Vibration and Hyperventilation-induced Nystagmus from Vestibular Schwannoma𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This 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 righ...Image/MovingImage
89 Acute Vestibular Syndrome With Skew Deviation and Positive Head Impulse Test Due to a Demyelinating LesionThis is a patient who initially presented with the acute vestibular syndrome (AVS, e.g., acute prolonged vertigo, spontaneous nystagmus). ; See https://collections.lib.utah.edu/details?id=187730 for additional history. ; Her HINTS (Head Impulse, Nystagmus, Test of Skew) testing indicated a central e...Image/MovingImage
90 Central Acute Vestibular Syndrome Due to Posterior Fossa HemorrhageThis 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...Image/MovingImage
91 Demonstration of HINTS Examination in a Normal SubjectIn the acute vestibular syndrome - consisting of acute prolonged vertigo, spontaneous nystagmus, imbalance, nausea/vomiting, head motion intolerance which is typically due to vestibular neuritis or posterior fossa stroke - a 3 step test of ocular motor and vestibular function known as HINTS, has hig...Image/MovingImage
92 Oculogyric Crisis𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a patient with neuroleptic-induced oculogyric crisis. 𝗡𝗲𝘂𝗿𝗼-𝗼𝗽𝗵𝘁𝗵𝗮𝗹𝗺𝗼𝗹𝗼𝗴𝘆 𝗮𝗻𝗱 𝗡𝗲𝘂𝗿𝗼-𝗼𝘁𝗼𝗹𝗼𝗴𝘆 𝗧𝗲𝘅𝘁𝗯�...Image/MovingImage
93 Anti-GAD Associated Cerebellopathy and Bilateral VestibulopathyThis is a 70-year-old woman with the subacute onset of severe imbalance and dizziness. On her initial examination, she had prominent gaze-evoked nystagmus and bilateral vestibular loss. Smooth pursuit was saccadic, although her vestibulo-ocular reflex (VOR) suppression was much smoother. Usually pur...Image/MovingImage
94 Brainstem Ocular Motor MachinerySeen 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...Image/MovingImage
95 Unilateral 3rd, 4th, and 6th Nerve Palsies Due to Cavernous Sinus Meningioma𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 50-year-old woman presenting with a partial 3rd nerve palsy (mild pupil involvement), partial 6th nerve palsy, and no clear incyclotorsion with downgaze, suggestive of additional 4th nerve palsy, all on the left...Image/MovingImage
96 One-and-a-Half Syndrome Due to Pontine HemorrhageThis is a 50-year-old woman who, while exercising in the gym, suddenly experienced vertigo, nausea, vomiting, tingling in the left arm, and diplopia. MRI demonstrated a brainstem hemorrhage that involved the right greater than left pons. Examination demonstrated a right horizontal gaze palsy due to ...Image/MovingImage
97 Leukemic Leptomeningeal Carcinomatosis Causing 4th and 6th Nerve Palsies𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 55-yo-man with CML that recurred as AML. Diagonal diplopia developed, and on examination he was found to have a partial right 6th nerve palsy, in addition to a left hypertropia that increased in right gaze, down...Image/MovingImage
98 Typical Features of Duane Syndrome Type 1𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a patient seen for vestibular complaints, who on exam, was found to have (unrelated to her vestibular symptoms) impaired abduction OS. In adduction, there was narrowing of the palpebral fissure OS, a result of glo...Image/MovingImage
99 + HIT, + Skew, Unidirectional Nystagmus: Central Acute Vestibular Syndrome Due to Wallenberg SyndromeThis is a 45-year-old woman who presented to the ED with acute prolonged vertigo and vertical diplopia. She was seen as an outpatient 1 month after her ED visit, and double vision and balance were improving by that time. Her HINTS testing showed the following (seen in the video): 1) Head Impulse - A...Image/MovingImage
100 Periodic Alternating Nystagmus and Perverted Head-shaking Nystagmus in Cerebellar Degeneration𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 60-yo-woman with several years of worsening imbalance, diplopia (hers was actually unrelated to cerebellar pathology [although she did have an esotropia greater at distance that was cerebellar in origin] and due...Image/MovingImage
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