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TitleDescriptionSubject
176 Test Your Knowledge - Acute prolonged vertigoThis is a 60-year old man with diabetes presenting with acute onset prolonged vertigo that was ongoing at the time of this examination. Which of the following statements are true with regard to the localization and/or etiology of this patient's symptoms? ; A.; Whether or not symptoms worsen with he...Abnormal Alignment, Jerk Nystagmus, Vestibular Nystagmus, Acute Vestibular Syndrome, Video Head Impulse Test
177 Test Your Knowledge - Central and peripheral vestibular and ocular motor signs due to a large vestibular schwannomaWhich of the following is least likely to be the correct localization or etiology given the findings seen in the video? ; 1); Acute right 8th cranial neuropathy ; 2); Right-sided vestibular schwannoma; 3); Right vestibular nucleus infarction ; 4); Right anterior inferior cerebellar artery distributi...Abnormal VOR, Jerk Nystagmus, Vestibular Nystagmus, Gaze Evoked Nystagmus, Bruns Nystagmus, Cerebellar OMS,
178 Test Your Knowledge - Monocular OscillopsiaWhich of the following associated signs is most likely to be seen in this patient presenting with oscillopsia? ; A.; Optic nerve pallor ; B.; Palatal tremor; C.; Severe unilateral cataract ; D.; Head bobbing; E.; Neurovascular contact on MR CISS/FIESTA imaging; ; A.; Correct. This patient has MS an...Pendular Nystagmus
179 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...Skew
180 Test Your Knowledge - Optokinetic nystagmus with a parietal lesionGiven the finding seen in the first part of the video, which of the following associated features are most likely? (more than one answer may be correct); A.; Left homonymous visual field defect; B.; Right homonymous visual field defect; C.; Visual neglect and/or extinction; D.; Alexia without agraph...Abnormal OKN, Jerk Nystagmus
181 Test Your Knowledge - OscillopsiaThis 65-year-old man with multiple sclerosis described that objects in front of him appear to spontaneously jump or move horizontally for the last few months. He reported that his symptoms occur independent of head movements and head impulse testing was normal. After viewing the video, what is the m...Pendular Nystagmus, Jerk Nystagmus, Abducting Nystagmus, Internuclear Ophthalmoplegia
182 Test Your Knowledge - The acute vestibular syndrome and ptosisWhat is the most likely localization in this patient presenting with vertical diplopia and acute onset prolonged vertigo? ; A.; Right medial longitudinal fasciculus (MLF); B.; Left medial longitudinal fasciculus ; C.; Right medulla; D.; Left medulla; E.; Left midbrain; ; A.; Incorrect. A right MLF l...Jerk Nystagmus, Acute Vestibular Syndrome, Vestibular Nystagmus, Skew Deviation, Upbeat Nystagmus, Torsional Nystagmus, Rotary Nystagmus, Horner Syndrome
183 Test Your Knowledge - Vertical saccadic palsy due to bilateral riMLF infarctionsThis is a 30-year-old who was found minimally responsive on the lounge floor of an ice skating rink. He was brought to the ED, where he had a GCS score of 8 (where 15 is normal) for poor responsiveness. His ocular motor exam is shown in the video.; ; Regarding Finding #1, which of the following is f...Abnormal Saccades, Normal Optokinetic, Abnormal Range, Vertical Gaze Palsy, Upgaze Palsy, Downgaze Palsy, Mesencephalon, Ocular Motor
184 Test Your Knowledge - Vertical-torsional nystagmusQuestion #1:; Watch the first portion of the video until you are told to stop. Is this vestibular nystagmus more likely to be peripheral or central? ; A.; Peripheral ; B.; Central ; Answer for #1:; A.; Incorrect. While the patient has upbeat-torsional (top poles beating toward the right ear) nystagm...Jerk Nystagmus, Rotary Nystagmus, Upbeat Nystagmus, INO, Skew, Abnormal Alignment, Abnormal Saccades, Vestibular Nystagmus, Acute Vestibular Syndrome
185 Test your knowledge - Bilateral 4th nerve palsiesWatch the video until instructed to stop. Which of the following features is likely to be present given her exam findings? ; a.; Gaze-evoked nystagmus and impaired smooth pursuit; b.; History of traumatic brain injury; c.; History of blepharoplasty or brow lift surgery and prominence of superior su...Abnormal Alignment, Fourth Nerve, Trochlear Nerve
186 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 bilatera...Normal Convergence, Vertical Gaze Palsy, Upgaze Palsy, Dorsal Midbrain, Mesencephalon, Convergence Retraction
187 Test your knowledge: The acute vestibular syndrome with gaze-evoked nystagmus and bilaterally abnormal head impulse testing due to middle cerebellar peduncle and flocculus hemorrhageThis is a 70-year-old woman with a history of atrial fibrillation on warfarin presenting with acute prolonged vertigo and imbalance. In addition to the findings demonstrated in the first part of the video, what else should be seen to reassure the examiner that the etiology of her vertigo is benign? ...Abnormal VOR, Jerk Nystagmus, Acute Vestibular Syndrome, Cerebellar OMS, Gaze Evoked Nystagmus,
188 Testing for adduction lag in partial INO using an optokinetic stimulusIn this patient we demonstrate the use of an optokinetic stimulus to elicit an internuclear ophthalmoplegia (INO). Occasionally adduction appears to be normal with an INO, and an adduction lag with horizontal saccades should be sought as a confirmatory sign. Optokinetic tape is an easy way to assess...INO, Jerk Nystagmus
189 The acute vestibular syndrome in MS due to middle cerebellar peduncle/root entry zone lesionThis is a 13 year-old girl with relatively abrupt onset vertigo and oscillopsia. On exam, there was primarily right-beating nystagmus in primary gaze with a slight upward (upbeat) component, giving the nystagmus an oblique appearance. The upward component and lack of a clear torsional component acut...Jerk nystagmus; Vestibular nystagmus; Vestibulo-ocular reflex; Head impulse testing; Gaze-evoked nystagmus
190 The acute vestibular syndrome with dysarthria, dysphagia, dysphonia, hemi-ataxia, and saccadic dysmetria due to the lateral medullary (Wallenberg) syndromeThis is a 50-year-old woman with the acute onset of vertigo, dysarthria, dysphagia and dysphonia/hoarseness (nucleus ambiguus), ptosis and imbalance. Her examination localized to a left lateral medullary (Wallenberg) syndrome - there was decreased sensation on the left side of the face (spinal trige...Acute Vestibular Syndrome, Ninth Nerve, OMS Medulla, Abnormal Saccades, Tenth Nerve, Lateropulsion, Horner Syndrome
191 The acute vestibular syndrome with skew deviation, gaze-evoked nystagmus, and bilaterally abnormal head impulse testing due to AICA strokeThis is a 60-year-old man with the acute onset of prolonged vertigo and nystagmus, consistent with the acute vestibular syndrome (AVS). HINTS (Head Impulse, Nystagmus, Test of Skew) exam demonstrated a central pattern: 1) Head impulse test (HIT) was abnormal to the right and to the left. An abnormal...Abnormal VOR-HIT, Abnormal Alignment, Skew, Jerk Nystagmus, Gaze Evoked Nystagmus, Acute Vestibular Syndrome, Seventh Nerve, OMS Pons, OMS Cerebellar
192 The apogeotropic variant of horizontal canal BPPVThis is a patient with the apogeotropic (nystagmus beating towards the sky) variant of right horizontal canal (HC) benign paroxysmal positional vertigo (BPPV). In a patient with geotropic (nystagmus beating towards the ground) HC BPPV, by rapidly moving from a sitting to a supine position with the h...BPPV Horizontal, BPPV Diagnosis, Jerk Nystagmus, Vestibular Nystagmus
193 The episodic vestibular syndromeThis is a 55-year-old man with 6 months of episodic vertigo without clear triggers/provocative factors, with each of his 3 previous episodes lasting less than 5 minutes. While in the clinic, he had one of his typical vertigo attacks. There was initially 30 seconds of right-beating-torsional nystagmu...Jerk Nystagmus, Acute Vestibular Syndrome
194 The geotropic variant of horizontal canal BPPVThis is a patient with the geotropic (nystagmus beating towards the ground) variant of left horizontal canal (HC) benign paroxysmal positional vertigo (BPPV). In a patient with geotropic (nystagmus beating towards the ground) HC BPPV, by rapidly moving from a sitting to a supine position with the he...BPPV Horizontal, BPPV Diagnosis, Jerk Nystagmus, Vestibular Nystagmus
195 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...Vestibular Examination, Vestibular Lab Testing
196 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 syndromeSummary and Review
197 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 ...Vestibular Examination
198 The utriculo-ocular motor pathways - physiologic and pathologic ocular tilt reaction: OTR Diagram Pathologic EOMs Labelled (Figure 3)A skew deviation is a non-paralytic vertical ocular misalignment that is due to imbalance in the utriculo-ocular motor pathways. While vestibular jerk nystagmus is a consequence of static semicircular canal pathway imbalance (e.g., left-beating nystagmus due to acute right vestibular hypofunction fr...Skew Deviation
199 The utriculo-ocular motor pathways - physiologic and pathologic ocular tilt reaction: Pathologic OTR (Figure 2)A skew deviation is a non-paralytic vertical ocular misalignment that is due to imbalance in the utriculo-ocular motor pathways. While vestibular jerk nystagmus is a consequence of static semicircular canal pathway imbalance (e.g., left-beating nystagmus due to acute right vestibular hypofunction fr...Skew Deviation
200 The utriculo-ocular motor pathways - physiologic and pathologic ocular tilt reaction: Physiologic ocular tilt reaction (OTR) (Figure 1)A skew deviation is a non-paralytic vertical ocular misalignment that is due to imbalance in the utriculo-ocular motor pathways. While vestibular jerk nystagmus is a consequence of static semicircular canal pathway imbalance (e.g., left-beating nystagmus due to acute right vestibular hypofunction fr...Skew Deviation
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