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Title | Description | Type |
151 |
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Acute Vestibular Syndrome With Skew Deviation and Positive Head Impulse Test Due to a Demyelinating Lesion | This is a patient who initially presented with the acute vestibular syndrome (AVS, e.g., acute prolonged vertigo, spontaneous nystagmus). ; See https://collections.lib.utah.edu/details?id=187730 for additional history. ; Her HINTS (Head Impulse, Nystagmus, Test of Skew) testing indicated a central e... | Image/MovingImage |
152 |
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Central Acute Vestibular Syndrome Due to Posterior Fossa Hemorrhage | This is a patient presenting with the acute vestibular syndrome (AVS, e.g., acute prolonged vertigo, spontaneous nystagmus) whose HINTS (Head Impulse, Nystagmus, Test of Skew) testing indicated a central etiology based on negative (normal) head impulse testing (HIT). Nystagmus was unidirectional and... | Image/MovingImage |
153 |
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Caloric Testing | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: Caloric testing is a peripheral vestibular test which takes advantage of the fact that the labyrinth is sensitive to temperature changes. Warm stimulation causes excitation of the semicircular canals while cold stimulatio... | Image/MovingImage |
154 |
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Anterior Canal - BPPV: Deep Head Hanging | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: Regardless or whether it is thought that the patient has right or left anterior canal (AC) involvement, the deep head hanging maneuver is performed in the same way. • First the patient is placed in the long-sitting posi... | Image/MovingImage |
155 |
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Horizontal Canal - BPPV: BBQ Roll to Treat the Right Side | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: To treat right horizontal canal (HC)-BPPV (each position maintained for at least 30 seconds or until nystagmus and/or vertigo cease): • First the patient is placed in the long-sitting position • Then in a supine posit... | Image/MovingImage |
156 |
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Horizontal Canal - BPPV: Gufoni for Right Apogeotropic | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: To treat the right apogeotropic (beating towards the sky with right ear down and with left ear down - e.g., left beating nystagmus with right supine roll test or with right ear down; right beating nystagmus with left supi... | Image/MovingImage |
157 |
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Summary of the Most Common Audio-Vestibular Testing | Chart describing common audio-vestibular testing. | Text |
158 |
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Posterior Canal - BPPV: Epley and Semont Maneuvers | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: Epley/canalith repositioning maneuver (CRP) To treat right posterior canal (PC)-BPPV (each position maintained for at least 30 seconds or until nystagmus and/or vertigo cease): • First the patient is placed in the long-... | Image/MovingImage |
159 |
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HINTS 'Plus' Patterns in the Acute Vestibular Syndrome Based on Location | HINTS ‘Plus' patterns in the acute vestibular syndrome based on location | Text |
160 |
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Demonstration of HINTS Examination in a Normal Subject | In the acute vestibular syndrome - consisting of acute prolonged vertigo, spontaneous nystagmus, imbalance, nausea/vomiting, head motion intolerance which is typically due to vestibular neuritis or posterior fossa stroke - a 3 step test of ocular motor and vestibular function known as HINTS, has hig... | Image/MovingImage |
161 |
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Active Head Impulse Test | Active 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 |
162 |
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Bilateral riMLF Syndrome Causing Vertical Saccadic Palsy and Loss of Ipsitorsional Fast Phases | This is a 60-year-old man who developed fatigue and diabetes insipidus about 12 months prior to this video, and MRI demonstrated hypothalamic enhancement at that time. Nine months prior to this video, he gradually noticed that he was unable to look down. Work-up for ischemic, infectious, inflammator... | Image/MovingImage |
163 |
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Convergence | Convergence: 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 |
164 |
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Dix-Hallpike | The 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 |
165 |
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Dynamic Visual Acuity | Dynamic 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 |
166 |
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Eye Handbook App for OKN | Optokinetic 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 |
167 |
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Fixation and Gaze Holding | Fixation 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 |
168 |
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How to Measure Ocular Alignment Virtually | Ocular 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 |
169 |
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Hyperventilation | Hyperventilation: 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 |
170 |
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Modified (Chair) Dix-Hallpike | The 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 |
171 |
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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 |
172 |
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Pinched Nose Valsalva | 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 |
173 |
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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 |
174 |
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Saccades | Saccades: 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 |
175 |
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Smooth Pursuit | Smooth 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 |