NOVEL - Daniel Gold Collection
 
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TitleDescriptionSubject
76 Rebound NystagmusThis is a 50-yo-man who presented for dizziness and imbalance. His exam demonstrated choppy smooth pursuit and VOR suppression as well as mild gait ataxia. There was mild right-beating nystagmus in right gaze and left-beating nystagmus in left gaze without vertical gaze-evoked nystagmus. Occasionall...Cerebellar; Jerk Nystagmus; Gaze Evoked Nystagmus; Rebound Nystagmus
77 Reversal of Vertical Nystagmus with Convergence in Anti-DPPX Encephalitis𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a man who initially presented with spontaneous upbeat and torsional nystagmus, which led to the diagnosis of anti-DPPX encephalitis (for further details on this patient's course and for a video of his nystagmus, s...Upbeat Nystagmus; Downbeat Nystagmus; Jerk Nystagmus; Gaze-Evoked Nystagmus
78 Saccadic Hypermetria and Ipsipulsion (Behind Closed Eyelids and with Vertical Saccades)𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 40-year-old woman who experienced oscillopsia and vertical diplopia, due to spontaneous torsional nystagmus and a skew deviation (right hypotropia), respectively. The symptom onset was 7 months prior to these vi...Jerk Nystagmus; Torsional Nystagmus; Saccades; Lateropulsion; Medulla
79 Sagging Eye Syndrome and Cerebellar Disease in Divergence Insufficiency𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 70-year-old woman who presented with diplopia at distance. Her exam demonstrated orthophoria at near with a fairly comitant 8-10 PD esotropia at distance without abduction paresis, consistent with divergence ins...Abnormal Alignment; OMS Cerebellar; Jerk Nystagmus; Gaze Evoked Nystagmus; Divergence Insufficiency
80 Sequelae of Cerebellar Hemorrhage - Gaze-evoked Nystagmus, Alternating Skew Deviation and Palatal TremorThis is a 75-yo-woman presenting with a gait disorder. Two years prior, she suffered a cerebellar hemorrhage. On examination, there were typical cerebellar ocular motor signs including gaze-evoked nystagmus, choppy smooth pursuit and VOR suppression, and saccadic dysmetria. There was also an alterna...Assessing Abnormal Alignment; Jerk Nystagmus; Gaze Evoked Nystagmus; Oculopalatal Myoclonus
81 Skew Deviation and Spontaneous Nystagmus Due to Posterior Fossa LesionsThis is a 50-year-old woman who reported the abrupt onset of imbalance, right upper extremity incoordination and binocular vertical diplopia several months prior to her presentation to our clinic. On examination, she had a left hypertropia that was fairly comitant (measuring 5 prism diopters) assoc...Abnormal Alignment; Jerk Nystagmus; Upbeat Nystagmus; Vestibular Nystagmus; Rotary Nystagmus; Skew Deviation
82 Spinocerebellar Ataxia Type 3 with Gaze-Evoked Nystagmus and Bilateral Vestibular Loss𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 50-year-old woman with an established diagnosis of spinocerebellar ataxia type 3 (SCA 3) with severe imbalance and head movement-induced oscillopsia. On examination, she had 1) bilateral vestibular loss (BVL) de...Jerk Nystagmus; Gaze-Evoked Nystagmus; Abnormal VOR-HIT; Eighth Nerve; Abnormal Pursuit
83 Spontaneous Torsional Nystagmus and Ocular Tilt Reaction𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 70-year-old man who experienced "a delay in focusing" with "some twisting movement" that began about 18 months prior to this video with mild progression over days or weeks. For the same period of time, he experi...Jerk Nystagmus; Rotary Nystagmus; Abnormal Alignment
84 Spontaneous Upbeat Nystagmus in Acute Wernicke's Encephalopathy𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 40-year-old woman presenting with imbalance, confusion and oscillopsia. Exam demonstrated upbeat nystagmus (UBN) in primary gaze that remained UB in all directions of gaze, with a slight torsional component (top...Upbeat Nystagmus; Jerk Nystagmus; Medullar OMS
85 Superior Canal Dehiscence𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 60-yo-man who complained of autophony (eg, hearing his own heartbeat, noting that his own voice sounded too loud) and dizziness triggered with loud noises and straining at times. With pinched-nose Valsalva maneu...Nystagmus; Superior Canal Dehiscence; Valsalva
86 Test Your Knowledge - Acute Prolonged VertigoThis is a 60-year old man with diabetes presenting with acute onset prolonged vertigo that was ongoing at the time of this examination. Which of the following statements are true with regard to the localization and/or etiology of this patient's symptoms? A. Whether or not symptoms worsen with head ...Abnormal Alignment; Jerk Nystagmus; Vestibular Nystagmus; Acute Vestibular Syndrome; Video Head Impulse Test
87 Test Your Knowledge - Central and Peripheral Vestibular and Ocular Motor Signs Due to a Large Vestibular SchwannomaWhich of the following is least likely to be the correct localization or etiology given the findings seen in the video? 1) Acute right 8th cranial neuropathy 2) Right-sided vestibular schwannoma 3) Right vestibular nucleus infarction 4) Right anterior inferior cerebellar artery distribution stroke A...Abnormal VOR; Jerk Nystagmus; Vestibular Nystagmus; Gaze Evoked Nystagmus; Bruns Nystagmus; Cerebellar OMS
88 Test Your Knowledge - Optokinetic Nystagmus with a Parietal Lesion𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: Given the finding seen in the first part of the video, which of the following associated features are most likely? (more than one answer may be correct) A. Left homonymous visual field defect B. Right homonymous visual fi...Abnormal OKN; Jerk Nystagmus
89 Test Your Knowledge - OscillopsiaThis 65-year-old man with multiple sclerosis described that objects in front of him appear to spontaneously jump or move horizontally for the last few months. He reported that his symptoms occur independent of head movements and head impulse testing was normal. After viewing the video, what is the m...Pendular Nystagmus; Jerk Nystagmus; Abducting Nystagmus; Internuclear Ophthalmoplegia
90 Test Your Knowledge - The Acute Vestibular Syndrome and PtosisWhat is the most likely localization in this patient presenting with vertical diplopia and acute onset prolonged vertigo? A. Right medial longitudinal fasciculus (MLF) B. Left medial longitudinal fasciculus C. Right medulla D. Left medulla E. Left midbrain A. Incorrect. A right MLF lesion (stroke, M...Jerk Nystagmus; Acute Vestibular Syndrome; Vestibular Nystagmus; Skew Deviation; Upbeat Nystagmus; Torsional Nystagmus; Rotary Nystagmus; Horner Syndrome
91 Test Your Knowledge - Vertical-Torsional NystagmusQuestion #1: Watch the first portion of the video until you are told to stop. Is this vestibular nystagmus more likely to be peripheral or central? A. Peripheral B. Central Answer for #1: A. Incorrect. While the patient has upbeat-torsional (top poles beating toward the right ear) nystagmus which is...Jerk Nystagmus; Rotary Nystagmus; Upbeat Nystagmus; INO; Skew; Abnormal Alignment; Abnormal Saccades; Vestibular Nystagmus; Acute Vestibular Syndrome
92 Test Your Knowledge: The Acute Vestibular Syndrome with Gaze-Evoked Nystagmus and Bilaterally Abnormal Head Impulse Testing Due to Middle Cerebellar Peduncle and Flocculus HemorrhageThis is a 70-year-old woman with a history of atrial fibrillation on warfarin presenting with acute prolonged vertigo and imbalance. In addition to the findings demonstrated in the first part of the video, what else should be seen to reassure the examiner that the etiology of her vertigo is benign? ...Abnormal VOR; Jerk Nystagmus; Acute Vestibular Syndrome; Cerebellar OMS; Gaze Evoked Nystagmus
93 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...INO; Jerk Nystagmus
94 The Acute Vestibular Syndrome in MS Due to Middle Cerebellar Peduncle/Root Entry Zone LesionThis is a 13 year-old girl with relatively abrupt onset vertigo and oscillopsia. On exam, there was primarily right-beating nystagmus in primary gaze with a slight upward (upbeat) component, giving the nystagmus an oblique appearance. The upward component and lack of a clear torsional component acut...Jerk Nystagmus; Vestibular Nystagmus; Vestibulo-ocular Reflex; Head Impulse Testing; Gaze-evoked Nystagmus
95 The Acute Vestibular Syndrome with Skew Deviation, Gaze-evoked Nystagmus, and Bilaterally Abnormal Head Impulse Testing Due to AICA StrokeThis is a 60-year-old man with the acute onset of prolonged vertigo and nystagmus, consistent with the acute vestibular syndrome (AVS). HINTS (Head Impulse, Nystagmus, Test of Skew) exam demonstrated a central pattern: 1) Head impulse test (HIT) was abnormal to the right and to the left. An abnormal...Abnormal VOR-HIT; Abnormal Alignment; Skew; Jerk Nystagmus; Gaze Evoked Nystagmus; Acute Vestibular Syndrome; Seventh Nerve; OMS Pons; OMS Cerebellar
96 The Apogeotropic Variant of Horizontal Canal BPPV𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a patient with the apogeotropic (nystagmus beating towards the sky) variant of right horizontal canal (HC) benign paroxysmal positional vertigo (BPPV). In a patient with geotropic (nystagmus beating towards the gr...BPPV Horizontal; BPPV Diagnosis; Jerk Nystagmus; Vestibular Nystagmus
97 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...Jerk Nystagmus; Acute Vestibular Syndrome
98 The Geotropic Variant of Horizontal Canal BPPV𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a patient with the geotropic (nystagmus beating towards the ground) variant of left horizontal canal (HC) benign paroxysmal positional vertigo (BPPV). In a patient with geotropic (nystagmus beating towards the gro...BPPV Horizontal; BPPV Diagnosis; Jerk Nystagmus; Vestibular Nystagmus
99 Torsional Jerk NystagmusPresented here are 3 patients with torsional jerk nystagmus. The first patient presented with vertigo and experienced oscillopsia due to her torsional nystagmus. Pure or predominantly torsional nystagmus is highly suggestive of a central process. Her nystagmus was unidirectional and followed Alexand...Medulla; Cerebellar; Jerk Nystagmus; Rotary Nystagmus
100 Torsional Nystagmus Due to Medullary Pilocytic Astrocytoma𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 30-year-old woman who experienced headaches which led to an MRI and the diagnosis of a right medullary pilocytic astrocytoma, confirmed pathologically. Examination was performed a year after the initial diagnosi...Jerk Nystagmus; Rotary Nystagmus; OMS Medulla
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