NOVEL - Daniel Gold Collection
 
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TitleDescriptionType
101 Pinched Nose ValsalvaValsalva (closed glottis or pinched nose): instruct the patient to take a deep breath and ‘bear down' (closed glottis) or take a deep breath and ‘try to pop their ears' (pinched nose). Assess for nystagmus. In superior canal dehiscence, pressure changes may be transmitted to the superior canal, ...Image/MovingImage
102 VibrationVibration: instruct the patient to self-administer this test with an electric toothbrush or vibrator/massager, if available. Vibration of the mastoids and vertex will induce an ipsilesional slow phase with unilateral vestibular loss (https://collections.lib.utah.edu/details?id=1427582).Image/MovingImage
103 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...Image/MovingImage
104 Dix-HallpikeThe safety of the patient should be prioritized when completing this test virtually, and the examiner should avoid putting the patient in a position where a fall may occur. Floor (or bed) Dix-Hallpike: this test can be used for patients who are fully mobile and able to get down to the floor and up a...Image/MovingImage
105 Modified (Chair) Dix-HallpikeThe safety of the patient should be prioritized when completing this test virtually, and the examiner should avoid putting the patient in a position where a fall may occur. Modified (chair) Dix-Hallpike:(1) this test can be used for patients who may not be able to safely undertake the traditional Di...Image/MovingImage
106 SaccadesSaccades: instruct the patient to make rapid movements of their eyes in each gaze direction, noting the speed, conjugacy, latency, and accuracy. First have the patient look between an eccentric target and the camera horizontally and vertically, making assessment of accuracy easier - e.g., overshooti...Image/MovingImage
107 VOR SuppressionVOR suppression (VORS): instruct the patient to fix on the camera which they should hold in front of their eyes, while turning their torso slowly in the horizontal plane. The vertical plane can then be assessed by instructing the patient to flex and extend the neck under the same conditions. A demon...Image/MovingImage
108 Active Head Impulse TestActive head impulse test (HIT): instruct the patient to fix their eyes on the camera and turn their head 20o to the right/left, and then make a rapid movement toward the midline to align their head with the camera again, keeping their eyes fixed on the camera throughout. A simple instruction is to a...Image/MovingImage
109 ConvergenceConvergence: instruct the patient to focus on their thumb held at arm's length, and slowly move their thumb towards their nose. This may bring out or cause reversal of vertical nystagmus (e.g., transition from upbeat to downbeat nystagmus in Wernicke's encephalopathy [see example of transition from ...Image/MovingImage
110 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...Image/MovingImage
111 Range of Motion (Ductions)Range of motion (ductions): check the range of each individual eye (ductions) if there is diplopia or if a motility deficit is suspected. Instructing the patient to hold their head 20o to the right or to the left may provide a better view of the range of horizontal gaze, if there is diplopia or if a...Image/MovingImage
112 Smooth PursuitSmooth pursuit: instruct the patient to hold their head steady, fix their eyes on the camera and slowly move the camera in the horizontal and vertical planes. Or, have the patient focus on their outstretched thumbnail (or other small fixation target), while following the slowly moving object horizon...Image/MovingImage
113 Supine Roll TestSupine roll test: used to test for horizontal canal (HC) BPPV. While horizontal nystagmus due to HC-BPPV is often seen with DH, the roll test will usually maximize nystagmus and vertigo with the HC variant. The patient can be guided through a self-administered supine roll test while lying on the flo...Image/MovingImage
114 Dynamic Visual AcuityDynamic Visual Acuity: the examiner can use screen-sharing to provide a visual acuity chart. Instruct the patient to sit at the appropriate distance from their screen at which the lowest line on the visual acuity chart is just readable. Have the patient move their head (horizontally to evaluate the ...Image/MovingImage
115 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...Image/MovingImage
116 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...Image/MovingImage
117 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...Image/MovingImage
118 Penlight Cover Test (Partial Removal of Fixation)Penlight cover test (partial removal of fixation): during in-person clinical encounters, the maneuvers below are best tested with complete (or near complete) removal of fixation (e.g., Frenzel or video Frenzel goggles). Removal of fixation is more challenging during virtual evaluations but can be ap...Image/MovingImage
119 Valsalva (Closed Glottis)Valsalva (closed glottis or pinched nose): instruct the patient to take a deep breath and ‘bear down' (closed glottis) or take a deep breath and ‘try to pop their ears' (pinched nose). Assess for nystagmus. In superior canal dehiscence, pressure changes may be transmitted to the superior canal, ...Image/MovingImage
120 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...Image/MovingImage
121 Abnormal Visually-enhanced Vestibulo-ocular Reflex (vVOR) in Cerebellar Ataxia, Neuropathy, Vestibular Areflexia Syndrome (CANVAS)𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This patient complained of chronic (unexplained cough), progressive numbness in the legs and feet, gait instability, and oscillopsia when walking or with head movements. Examination showed excessive square-wave jerks, bil...Image/MovingImage
122 Expanded Nystagmus & Saccadic Intrusions/Oscillations DifferentialExpanded nystagmus & saccadic intrusions/ oscillations differentialText
123 Saccadic Intrusions (Square Wave Jerks, SWJ)𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: Seen here are SWJ, which is the most common example of a saccadic intrusion. Here the patient is fixating on the camera, and all of the sudden a saccade takes the eyes off the fixation target, there's a brief intersaccadi...Image/MovingImage
124 An Optokinetic Stimulation Home Exercise Program𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: A plainly written program of optokinetic exercise intended for patient use at home. 𝗡𝗲𝘂𝗿𝗼-𝗼𝗽𝗵𝘁𝗵𝗮𝗹𝗺𝗼𝗹𝗼𝗴𝘆 𝗮𝗻𝗱 𝗡𝗲𝘂𝗿𝗼-𝗼𝘁𝗼𝗹𝗼𝗴𝘆 ...Text
125 Expanded Acute Onset Persistent Vision Loss DifferentialText
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