NOVEL - Daniel Gold Collection
 
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126 Liberatory or Modified Semont, Posterior Canal Benign Paroxysmal Positional Vertigo (BPPV) for Right Posterior Canal BPPV (Canalithiasis or Cupulolithiasis)Posterior canal (PC) accounts for 70-90% cases of BPPV [1-3] and resolves with canalith repositioning maneuvers 90% of the time [4-13]. The Semont/Liberatory maneuver is considered a gold-standard treatment, with class 1 evidence for use and success rates close to 90% [4-13].The Liberatory maneuver ...Image/MovingImage
127 Li Maneuver for Geotropic Right HC-BPPV, Canalithiasis (Video)The Li maneuver is used to treat horizontal canal, canalithiasis. When compared to the Gufoni maneuver, the Li maneuver was as effective to treat HC-BPPV and there was no significant difference between the maneuvers; however, the Li Maneuver may take less time to complete. 1. The patient starts in a...Image/MovingImage
128 Gufoni Maneuver for Left Horizontal Canal BPPV, Canalithiasis (Geotropic Nystagmus) (Video)The Gufoni maneuver may be preferable to the BBQ roll, as the Gufoni maneuver does not require the individual to roll or be in a prone position, making the maneuver more feasible to complete for individuals who are elderly, obese and/or experience immobility. Antecedently, some clinicians remember t...Image/MovingImage
129 Brandt-Daroff Exercises (Video)Brandt-Daroff exercises are less effective than the Epley and the Semont maneuvers and are not shown to prevent recurrence [1-3]. Brandt-Daroff exercises may still be beneficial for habituation exercises and to reduce phobic responses to lying supine or side-lying after the resolution of BPPV. This ...Image/MovingImage
130 BBQ Roll for Right Horizontal Canal BPPV, Canalithiasis (Geotropic Nystagmus) (Video)The BBQ Roll/Lampert Maneuver has been shown to be an effective treatment and is supported by a level I classification study. 1. The patient starts in a supine position with the head positioned 30 degrees above the horizon. 2. While maintaining head elevation, the patient's head (or whole body) is r...Image/MovingImage
131 Trigeminal Neuropathy with Loss of the Corneal ReflexThis is a woman who underwent radiofrequency ablation for left trigeminal neuralgia. Examination demonstrated loss of facial sensation on the left in addition to an absent corneal reflex on the left, consistent with involvement of the V1 (ophthalmic) branch of the trigeminal nerve. When the cornea i...Image/MovingImage
132 Typical Lid Signs (Cogan's Lid Twitch, Lid Hopping, Enhanced Ptosis) in Myasthenia Gravis𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 60-yo-woman with MG who displays typical eyelid signs including Cogan's lid twitch, lid hopping (appreciated during horizontal smooth pursuit in this patient), and enhanced ptosis in accordance with Hering's law...Image/MovingImage
133 Prolonged Lid Twitch in Myasthenia GravisThis 50-yo-woman with ocular MG demonstrated a spontaneous and particularly prolonged eyelid twitch.Image/MovingImage
134 Internuclear Ophthalmoplegia (INO) in Multiple Sclerosis𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This video includes 3 patients each with a known history of MS found to have unilateral or bilateral INOs on their exam. In the first 2 patients, the INOs are relatively subtle with normal adduction. However, with rapid h...Image/MovingImage
135 Bilateral INOs and Partial 3rd Nerve PalsiesThis is a 45-year-old man with progressive ptosis and ophthalmoparesis. 10 years prior to presentation, he experienced diplopia and had a hyperintense lesion involving the medial longitudinal fasciculus (MLF) per report. Over time, he developed bilateral adduction paresis, ptosis and upgaze paresis ...Image/MovingImage
136 Wall-eyed Bilateral INO in Caudal Midbrain LesionThis is a 30-yo-woman with the relatively acute onset of diplopia. There was a large angle exotropia, very subtle lag of the adducting saccades OD>OS, suggestive of bilateral INOs. This was best seen with rapid horizontal saccades, and a lesion involving bilateral MLFs in the caudal midbrain was dem...Image/MovingImage
137 Pseudo-INOs in Myasthenia GravisThis is a 55-yo-woman with an intermittent exotropia who had normal adduction OU, but clear lag of adducting saccades OD>OS with rapid horizontal saccades. This was much more apparent after repeat testing (ie, it was fatigable), and she wound up having ocular MG.Image/MovingImage
138 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
139 Two Patients with Parinaud's Syndrome with Slow Upward Saccades and Normal Upward Range of MovementsPresented here are two patients with Parinaud's syndrome: Patient 1) suffered a hemorrhage of the dorsal midbrain causing slow upward saccades (with convergence retraction nystagmus, but normal vertical range of eye movements), and light-near dissociation, and Patient 2) had a germinoma of the dorsa...Image/MovingImage
140 Parinaud's Syndrome with Impaired Upward Saccades and Otherwise Normal Vertical Eye MovementsThis is a 50-yo-man who suffered a dorsal midbrain stroke. Exam demonstrated normal vertical range of eye movements, normal vertical VOR and smooth pursuit, but inability to perform upward saccades. Another feature of Parinaud's syndrome seen on his exam was light-near dissociation (not shown in thi...Image/MovingImage
141 Central Positional Vertigo and Nystagmus in a Posterior Fossa Tumor𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 30-year old woman who presented with positional vertigo and vomiting following a concussion related to a car accident 3 months prior. She was initially diagnosed with posterior canal (PC) benign paroxysmal posit...Image/MovingImage
142 Downbeat Nystagmus with Active Horizontal Head ShakingThis is a 70-year-old man who presented with one single complaint for 10 years - if he moved his head too quickly (even one single horizontal head movement to the right or the left), he would experience the abrupt loss of balance and dizziness. His typical episodes were reproducible, and interesting...Image/MovingImage
143 Periodic Alternating Nystagmus and Central Head-Shaking Nystagmus from Nodulus Injury𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 35-year-old man who suffered a gunshot wound to his cerebellum. When he regained consciousness days later, he experienced oscillopsia due to periodic alternating nystagmus (PAN). He was started on baclofen 10 mg...Image/MovingImage
144 Ocular Motor Signs of Cerebellar Ataxia - Gaze-Evoked Nystagmus, Saccadic Pursuit, and VOR Supression𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 30-year-old woman with a several year long history of imbalance due to cerebellar ataxia of unclear etiology. Seen in this video are common ocular motor signs in patients with advanced cerebellar dysfunction inc...Image/MovingImage
145 Slow Horizontal, Vertical and Oblique Saccades in Spinocerebellar Ataxia Type IThis is a patient presenting with horizontal diplopia who was found to have divergence insufficiency, an esotropia greater at distance than near in the absence of abduction paresis. She also had very slow saccades, more so vertically than horizontally. This is particularly noticeable when asking h...Image/MovingImage
146 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...Image/MovingImage
147 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...Image/MovingImage
148 Central (Nuclear) 3rd Nerve PalsiesShown here are two patients with left sided midbrain pathology (hemorrhage and ischemia) which caused damage to the 3rd nucleus. Both of the patients have ipsilateral mydriasis, adduction, supra- and infraduction paresis. Ipsilateral>contralateral ptosis is also present, and localizes to the central...Image/MovingImage
149 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...Image/MovingImage
150 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
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