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TitleDescriptionType
101 Monocular downbeat nystagmus due to a posterior fossa cystThis is a 40-yo-man who experienced months of imbalance and was found to have an epidermoid cyst (immediately posterior to the 4th ventricle), which was resected. Months after surgery, he experienced monocular vertical oscillopsia. On examination, there was subtle downbeat nystagmus (DBN) in the rig...Image/MovingImage
102 Monocular horizontal pendular nystagmus in MSBoth of these patients have MS and monocular (OS) horizontal pendular nystagmus. The first patient seen in the video has normal afferent function and no evidence of optic nerve disease in either eye, while the second patient has severe OS>>OD optic nerve disease related to bouts of optic neuritis (t...Image/MovingImage
103 The most common audiovestibular laboratory tests, and the specific conditions in which they may assist in making or supporting the diagnosisVN = vestibular neuritis; VM = vestibular migraine; VP = vestibular paroxysmia; vHIT = video head impulse test; VNG = video-nystagmography; ENG = electronystagmography; VOG = video-oculography; VEMPs = vestibular evoked myogenic potentials; SCDS = superior canal dehiscence syndrome; BPPV = benign pa...
104 The most common vestibular conditions categorized by timing and triggers, with specific historical features that should be sought for each (adapted from Approach to the Ocular Motor and Vestibular History and Examination)BPPV = benign paroxysmal positional vertigo; SCDS = superior canal dehiscence syndrome; BVL = bilateral vestibular loss; PPPD = persistent postural perceptual dizziness; MDDS = Mal de debarquement syndrome
105 The most common vestibular conditions categorized by timing and triggers, with specific ocular motor and vestibular features that should be sought for eachHINTS+ = Head Impulse, Nystagmus, Test of Skew, ‘Plus' bedside assessment of auditory function; HIT = head impulse test; NP = nerve palsy; BPPV = benign paroxysmal positional vertigo; SCDS = superior canal dehiscence syndrome; BVL = bilateral vestibular loss; PPPD = persistent postural perceptual ...
106 Multiple cranial neuropathies due to glomus tumorThis is a woman who was diagnosed with a right sided glomus tumor, and subsequently underwent resection. Seen here are multiple cranial neuropathies related to the tumor itself as well as to the surgery. She cannot abduct the right eye due to a right CN VI palsy. She has a right lower motor neuron f...
107 Multiple lower cranial neuropathies following carotid endarterectomyThis is a patient who underwent a right carotid endarterectomy (CEA). Following the surgery, multiple right sided lower cranial nerves were involved. In his case, there was trapezius and sternocleidomastoid weakness and atrophy on the right, indicative of right CN XI injury. There was an absent gag ...
108 Neuro-ophthalmic features and pseudo-MG lid signs in Miller Fisher syndromeThis is a 51-year-old woman who presented with imbalance, acute onset dizziness and diplopia that developed over three days following two weeks of upper respiratory infection and bacterial conjunctivitis. When she was initially seen as an outpatient, nystagmus was noted to the right and left, and a ...
109 Neuro-ophthalmic features and pseudo-MG lid signs in Miller Fisher syndrome - Figure 1This is a 51-year-old woman who presented with imbalance, acute onset dizziness and diplopia that developed over three days following two weeks of upper respiratory infection and bacterial conjunctivitis. When she was initially seen as an outpatient, nystagmus was noted to the right and left, and a ...
110 Nystagmus due to paraneoplastic (anti-Yo) brainstem and cerebellar degenerationThis is a 40-yo-woman with anti-Yo antibody associated with ovarian cancer. Initial symptoms 2.5 years prior (to this video) included imbalance and dysarthria. She complained of oscillopsia which was due to her upbeat nystagmus (presumably the result of brainstem involvement), and diplopia (she had ...Image/MovingImage
111 Ocular AlignmentThese tests allow for detection of eso-, exo- or hyperdeviations (phorias (one eye viewing) or tropias (both eyes viewing) that can be seen with ocular motor palsy, skew deviation, or with cerebellar disease (commonly esodeviation greater at distance) Instructional ocular motor examination procedure...Image/MovingImage
112 Ocular bobbing due to hepatic encephalopathyThis is a 55-year-old man presented with hepatic encephalopathy, and found to have ocular bobbing. Head CT did not show any acute changes. Ocular bobbing almost always localizes to the pons, although cerebellar pathology has also (rarely) been identified as a cause. Typical bobbing consists of rhyth...Image/MovingImage
113 Ocular motor & vestibular features of the MLF syndromeThis 61-year-old woman with HTN and DM presented for evaluation of acute onset diagonal diplopia. Adduction OS was about 60% of normal while medialization OS improved with convergence. In right gaze, dissociated abducting nystagmus was present OD, and there was a clear adduction lag when asking he...
114 Ocular motor & vestibular features of the MLF syndrome - Figures 1, 2, and 3This 61-year-old woman with HTN and DM presented for evaluation of acute onset diagonal diplopia. Adduction OS was about 60% of normal while medialization OS improved with convergence. In right gaze, dissociated abducting nystagmus was present OD, and there was a clear adduction lag when asking he...
115 Ocular motor signs in early progressive supranuclear palsyThis is a 64-year old man who experienced imbalance and falls (usually backwards) for the last 6 months. He experienced difficulty navigating stairs and had become a messy eater (thought to be in large part due to his vertical gaze palsy), and had developed hypophonia. Exam demonstrated square wave ...
116 Ocular motor signs in progressive supranuclear palsy (PSP)This is a 65-yo-woman complaining of imbalance and double vision. She had significant convergence insufficiency (and would close her right eye with near viewing), providing an explanation for her diplopia. Convergence insufficiency is very common with parkinsonism. She had bradykinesia and rigidity,...Image/MovingImage
117 Ocular motor signs in SCA 6This is a 45-yo-man who was recently diagnosed with SCA 6. There was no clear spontaneous downbeat nystagmus (DBN) in primary gaze, although DBN could clearly be provoked by convergence. Other ocular motor features included choppy pursuit and VOR suppression horizontally and vertically, in addition ...
118 Oculogyric crisisThis is a patient with neuroleptic-induced oculogyric crisis.
119 Oculopalatal tremor and internuclear ophthalmoplegia due to hemorrhagic pontine cavernomaThis is a 60-year-old woman who experienced 2 episodes of vertigo, nausea and vomiting, which was felt to be related to recurrent hemorrhage of a pontine cavernoma that was adjacent to the fourth ventricle. The cavernoma was resected, and diplopia and left facial palsy were noted after the surgery. ...
120 Oculopalatal tremor and one-and-a-half syndrome due to pontine hemorrhageThis is a 65-year-old man who was put on a blood thinner, and shortly thereafter experienced a midline pontine hemorrhage, which was more dense on the left side. Immediately afterwards, right hemiparesis and hemi-anesthesia, left lower motor neuron (LMN) facial palsy and ophthalmoparesis were noted....
121 Oculopalatal tremor with prominent nystagmus, bilateral horizontal gaze palsy, and bilateral facial palsiesThis is a 50-year-old woman who experienced the acute onset of right sixth and seventh nerve palsies and left hemiparesis. Two cavernomas within the right pons (one in the region of the facial colliculus) were demonstrated by MRI. Five years after her initial presentation she developed recurrent r...
122 Oculopalatal tremor with prominent nystagmus, bilateral horizontal gaze palsy, and bilateral facial palsies Figure 1Figure 1, MRI T2 sequence demonstrating hyperintensities involving bilateral inferior olives of the medulla. This is a 50-year-old woman who experienced the acute onset of right sixth and seventh nerve palsies and left hemiparesis. Two cavernomas within the right pons (one in the region of the facia...
123 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 ...
124 One-and-a-half syndrome, facial palsy, and nystagmus due to dorsal pontine demyelinationThis is a 16-yo-girl with oscillopsia and double vision. Exam showed inability to look to the left with either eye due to left nuclear 6th. There was also a left INO (horizontal gaze palsy + INO = one-and-a-half syndrome) from left MLF involvement and left lower motor neuron facial palsy due to fasc...Image/MovingImage
125 Opsoclonus provoked by convergenceThis is a 40-yo-man with post-infectious opsoclonus-myoclonus syndrome. Opsoclonus was intermittently evident in primary position, but was consistently provoked (and intensified) by convergence. Occasionally, opsoclonus (back-to-back saccades in horizontal, vertical, torsional planes without an inte...Image/MovingImage
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