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176 Saccadic Smooth Pursuit and Vestibulo-ocular Reflex Suppression (VORS)𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 20-yo-man who suffered a left MCA stroke years prior. Upon evaluation of his eye movements, saccades and all classes of eye movements were normal, although his smooth pursuit and VORS were choppy to the left (ip...Image/MovingImage
177 Sagging Eye Syndrome and Cerebellar Disease in Divergence Insufficiency𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 70-year-old woman who presented with diplopia at distance. Her exam demonstrated orthophoria at near with a fairly comitant 8-10 PD esotropia at distance without abduction paresis, consistent with divergence ins...Image/MovingImage
178 Sequential Vasculopathic 3rd Nerve Palsies with Preserved 4th Nerve Function65-yo-man with uncontrolled diabetes who developed sequential vasculopathic 3rd nerve palsies. In attempted downgaze, there's clear incyclotorsion OU suggestive of preserved 4th nerve function on both sides. There was complete recovery over months. Video shows bilateral 3rd nerve palsies with intact...Image/MovingImage
179 Sitting & Walking Oscillopsia in a Patient with Bilateral Vestibular Loss & Head TremorThis is a 55-year-old man with oscillopsia for two reasons: He experienced oscillopsia at rest - so-called ‘sitting' oscillopsia - not from spontaneous nystagmus, but because of a combination of bilateral vestibular loss (BVL) and a mainly horizontal head tremor (this is sometimes referred to a...Image/MovingImage
180 Skew Deviation and the Triad of the Ocular Tilt Reaction (OTR)This is a patient who presented with vertical diplopia, who was found to have a complete ocular tilt reaction including the following features: (1) Skew deviation - right hypertropia that was about 30 prism diopters in all directions of gaze including right, left, up, down, as well as in right and ...Image/MovingImage
181 Slow Abducting Saccade in 6th Nerve Palsy40-yo-man with a right fascicular 6th nerve palsy due to stroke. There was improvement and only a minimal residual right abduction paresis OD by this visit, but still a relatively slow right abducting saccade seen in the video, especially apparent in the slow motion segment. Video shows slow abduct...Image/MovingImage
182 Spinocerebellar Ataxia Type 3 with Gaze-Evoked Nystagmus and Bilateral Vestibular Loss𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 50-year-old woman with an established diagnosis of spinocerebellar ataxia type 3 (SCA 3) with severe imbalance and head movement-induced oscillopsia. On examination, she had 1) bilateral vestibular loss (BVL) de...Image/MovingImage
183 Spontaneous Torsional Nystagmus and Ocular Tilt Reaction𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 70-year-old man who experienced "a delay in focusing" with "some twisting movement" that began about 18 months prior to this video with mild progression over days or weeks. For the same period of time, he experi...Image/MovingImage
184 Square Wave Jerks and Macrosaccadic Oscillations in a Patient with a Cerebellar TumorThis is a 40-year-old man who developed severe headaches, confusion, and gait imbalance which led to neuroimaging which demonstrated a midline cerebellar mass with compression of the fourth ventricle and obstructive hydrocephalus. He underwent a suboccipital craniectomy for resection of the mass, an...Image/MovingImage
185 Subtle Torsional Pendular Nystagmus in Oculopalatal Tremor (OPT)𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 50-year-old woman who presented with imbalance, and MRI demonstrated a right cerebellar cavernous malformation. She underwent surgery to resect the malformation, and post-operatively experienced right hemiparesi...Image/MovingImage
186 Superior Oblique Myokymia (SOM)𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a patient with transient monocular oscillopsia OD and vertical diplopia noted to have many episodes of SOM in the office. There was not only myokymia OD, but also a 4 prism diopter left hypertropia during episodes...Image/MovingImage
187 Superior Oblique Myokymia - Three Patients with Recorded Attacks Using VOG and Frenzel Goggles𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: Patients with superior oblique myokymia (SOM) commonly present with complaints of monocular oscillopsia and/or vertical diplopia, which are related to the primary and secondary actions of the SO (incycloduction and depres...Image/MovingImage
188 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
189 Test Your Knowledge - Ocular Tilt Reaction and Subjective Visual VerticalLesions of which of the following neuro-anatomic structures could result in the clinical findings shown? A. Right medulla B. Right interstitial nucleus of Cajal C. Right medial longitudinal fasciculus D. Left trochlear nerve E. Right caudal midbrain A. Correct. This patient presents with elements...Image/MovingImage
190 Test Your Knowledge - Parinaud's Syndrome in NeurosarcoidosisWatch the first segment of the video up to "Stop! What would you expect with vertical gaze?" and select the best response below. The patient also has mild right-beating nystagmus which can be ignored for the purposes of this question. A. The patient has pupillary findings consistent with bilateral 3...Image/MovingImage
191 Third and Sixth Nerve Palsies Due to Cavernous Sinus MeningiomaThis is a 60-year-old woman with a large meningioma that was compressing the right cavernous sinus. Examination demonstrated a pupil-involving right 3rd nerve palsy with near complete external ophthalmoplegia (involving levator palpebrae, medial rectus, superior rectus, inferior rectus). There was a...Image/MovingImage
192 Third Nerve Palsy Due to Tolosa Hunt SyndromeThis is a 20-year-old woman presenting with severe left eye pain and diplopia for several days. Examination was consistent with a pupil sparing left 3rd nerve palsy with complete external ophthalmoplegia (involving levator palpebrae, medial rectus, superior rectus, inferior rectus). Abduction OS was...Image/MovingImage
193 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
194 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
195 Traumatic 3rd Nerve Palsy with Aberrant Regeneration𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 20-yo-woman who experienced severe head trauma and diplopia upon awakening from a coma several weeks after the injury. She had a partial left 3rd nerve palsy (adduction spared), and when she looked to the right ...Image/MovingImage
196 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
197 Typical Features of Duane Syndrome Type 1𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a patient seen for vestibular complaints, who on exam, was found to have (unrelated to her vestibular symptoms) impaired abduction OS. In adduction, there was narrowing of the palpebral fissure OS, a result of glo...Image/MovingImage
198 Unidirectional Nystagmus in Lateral Medullary SyndromeThis is a 70-yo-man who presented with acute vertigo. Examination demonstrated very mild spontaneous torsional nystagmus (towards the right ear) in primary (not seen well in this video), with robust downbeat-torsional (towards right ear) nystagmus in right gaze and (less robust) almost pure torsiona...Image/MovingImage
199 Unidirectional Nystagmus Two Days After Onset of Vestibular NeuritisImage/MovingImage
200 Unidirectional Vestibular Nystagmus60-yo-man with recurrent vertigo attacks - this video was taken during one of his typical attacks, and shows left-beating nystagmus that stayed left-beating in all directions of gaze, more in left gaze (in accordance with Alexander's Law), and less in right gaze. This pattern is more commonly seen w...Image/MovingImage
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