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151 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
152 Paroxysmal Ocular Tilt Reaction𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 60-year-old woman who 2 years prior experienced a left sided hypertensive hemorrhagic stroke, resulting in right hemiparesis, dysarthria and vertical diplopia. The initial vertical diplopia resolved completely a...Image/MovingImage
153 Pendular Nystagmus𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is an example of pendular nystagmus, where like jerk nystagmus, the slow phase initiates the movement. However, unlike jerk nystagmus, there is no fast phase, but rather back to back slow phases resembling a pendulum...Image/MovingImage
154 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
155 Pendular Nystagmus and Vision LossThree patients are presented here, each with poor vision (counting fingers or worse) related to retinitis pigmentosa in one patient (Usher's syndrome) and optic neuropathy in two patients, each of whom developed pendular nystagmus after vision loss developed. Visually mediated movements normally pre...Image/MovingImage
156 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
157 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
158 Periodic Alternating Nystagmus Due to a Chiari MalformationThis patient first experienced oscillopsia 12 months prior to this video. Three months after the onset of symptoms, she was seen by neuro-ophthalmology and found to have a spontaneous, unidirectional left-beating nystagmus (that did not reverse) in addition to saccadic smooth pursuit. Oscillopsia wo...Image/MovingImage
159 Periodic Alternating Nystagmus Due to Nodulus StrokeThis is a 70-year-old woman who experienced the acute onset of vertigo and imbalance. MRI demonstrated a diffusion-weighted imaging hyperintensity involving the nodulus (with corresponding ADC hypointensity) consistent with an acute stroke. On examination several weeks after the stroke, periodic alt...Image/MovingImage
160 Periodic Alternating Nystagmus Due to Spinocerebellar Ataxia Type 6𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This 50-yo-man complained of imbalance for several years and more recently oscillopsia. On examination, there was saccadic pursuit and VOR suppression in addition to gaze-evoked nystagmus with rebound, raising suspicion f...Image/MovingImage
161 Physiologic End Point NystagmusThis is a normal subject with end point nystagmus in lateral gaze. Features that favor physiologic (normal) end point nystagmus (EPN) rather than pathologic gaze-evoked nystagmus include: only present in far lateral gaze (at close to 100% of the normal range of ocular movements); resolves when the v...Image/MovingImage
162 Pontine Hemorrhage Causing Oculopalatal Tremor and Multiple Cranial NeuropathiesThis is a 45-yo-woman who had a dorsal pontine cavernoma that bled 2 years prior to this video. Symptoms included diplopia and oscillopsia. On examination, she had left>right facial palsies (upper and lower face from involvement of the nucleus/fascicle - i.e., lower motor neuron palsies) and sixth n...Image/MovingImage
163 Positional Downbeat Nystagmus Mimicking Anterior Canal BPPVAlthough positional downbeat nystagmus (pDBN) can indicate the rare anterior canal variant of benign paroxysmal positional vertigo, central mimics are common causes of pDBN. pDBN may be seen in multiple system atrophy (MSA), or seen with posterior fossa lesions, with a common example being a stroke ...Image/MovingImage
164 Positional Nystagmus During an Attack of Vestibular Migraine𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: A 50-year-old woman presented to clinic after experiencing multiple episodes of hours-long vertigo attacks that were associated with headache, photophobia and phonophobia. She had a history of motion sickness and migraine...Image/MovingImage
165 Post-infectious Ocular Flutter and Myoclonus Syndrome𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 35-yo-woman presenting with oscillopsia following a viral illness. She described being easily startled, with "shakiness" of the head/neck and body. She had myoclonus and ocular flutter, with the latter evident w...Image/MovingImage
166 Posterior Canal BPPV with Fixation and with Fixation RemovedThis is a 60-yo-woman with positional vertigo. In the right Dix-Hallpike position with fixation removed, there was clear upbeat-torsional nystagmus (towards the lowermost right ear) which led to the diagnosis of right posterior canal BPPV. In right Dix-Hallpike with fixation there was mainly torsion...Image/MovingImage
167 Prolonged Lid Twitch in Myasthenia GravisThis 50-yo-woman with ocular MG demonstrated a spontaneous and particularly prolonged eyelid twitch.Image/MovingImage
168 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
169 PSP with Complete Ophthalmoplegia and Inability to Suppress the VOR𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 65-year-old woman presenting with visual complaints in the setting of advanced progressive supranuclear palsy (PSP). She had complete vertical and horizontal ophthalmoplegia, although the vestibulo-ocular reflex...Image/MovingImage
170 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...Image/MovingImage
171 Relative Afferent Pupillary Defect in Compressive Optic Neuropathy Due to Meningioma𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 35-year-old woman with a compressive optic neuropathy OS due to a meningioma. She had normal acuity and color OD, with 20/40 acuity and dyschromatopsia OS. There was loss of visual field OS with a mainly tempora...Image/MovingImage
172 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...Image/MovingImage
173 riMLF Syndrome from Artery of Percheron Stroke𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 65-yo-man who suffered the abrupt onset of loss of consciousness followed by difficulty looking down. MRI showed bilateral rostral midbrain strokes in the distribution of the artery of Percheron. He could not in...Image/MovingImage
174 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...Image/MovingImage
175 Saccadic Intrusions with an Intersaccadic Interval𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: Seen here are patients with saccadic intrusions that have preserved intersaccadic intervals. Although square wave jerks (SWJ) are present in everyone to some degree at times, when prominent or when they interfere with vis...Image/MovingImage
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