|
|
Title | Description | Subject |
201 |
|
Slow Abducting Saccade in 6th Nerve Palsy | 40-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... | Sixth (Abducens) Nerve Palsy; Abnormal Saccades |
202 |
|
Slow Horizontal, Vertical and Oblique Saccades in Spinocerebellar Ataxia Type I | This 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... | |
203 |
|
Slow Horizontal, Vertical, Oblique Saccades and Gaze-evoked Nystagmus in Anti-AGNA-1 Encephalitis | This is a patient who presented subacutely with imbalance and dizziness. On examination, she had evidence of gaze evoked nystagmus, right internuclear ophthalmoplegia, as well as slow saccades horizontally and vertically. She was diagnosed with a rare antibody-mediated disorder, anti-AGNA-1 (antig... | |
204 |
|
Slow Saccades Due to Unilateral Paramedian Pontine Reticular Formation (PPRF) Injury with Preserved Movements Using the Vestibulo-Ocular Reflex | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 60-year-old man who presented for imbalance and oscillopsia 10 months after surgery and 8 months after radiation for Merkel cell carcinoma of the neck. He developed imbalance after surgery and diplopia and osci... | Abnormal Saccades; Pons OMS; Sixth Abducens Nerve; Abnormal VOR; Vestibulocochlear Nerve; Horizontal Gaze Palsy |
205 |
|
Slow Volitional Saccades and Poor Fast Phases to an Optokinetic Stimulus, with Preserved Head Impulse Testing | This is a 67-year-old woman presenting with imbalance and binocular horizontal diplopia at near. On examination there were frequent square wave jerks, limited supraduction OU and convergence insufficiency, which explained her diplopia. Pursuit and suppression of the vestibulo-ocular reflex were sa... | Abnormal Saccades; VOR HIT Normal |
206 |
|
Smooth Pursuit | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: A pursuit deficit in one direction suggests an ipsilesional localization, but beware of a superimposed spontaneous nystagmus; a pursuit deficit in all directions is commonly seen with cerebellar lesions. 𝗡𝗲𝘂𝗿�... | Pursuit; Exam |
207 |
|
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... | Smooth Pursuit |
208 |
|
Spinocerebellar Ataxia Type 3 with Gaze-Evoked Nystagmus and Bilateral Vestibular Loss | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 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... | Jerk Nystagmus; Gaze-Evoked Nystagmus; Abnormal VOR-HIT; Eighth Nerve; Abnormal Pursuit |
209 |
|
Spontaneous Torsional Nystagmus and Ocular Tilt Reaction | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 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... | Jerk Nystagmus; Rotary Nystagmus; Abnormal Alignment |
210 |
|
Spontaneous Upbeat Nystagmus in Acute Wernicke's Encephalopathy | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 40-year-old woman presenting with imbalance, confusion and oscillopsia. Exam demonstrated upbeat nystagmus (UBN) in primary gaze that remained UB in all directions of gaze, with a slight torsional component (top... | Upbeat Nystagmus; Jerk Nystagmus; Medullar OMS |
211 |
|
Square Wave Jerks and Macrosaccadic Oscillations in a Patient with a Cerebellar Tumor | This 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... | Abnormal Saccades; Square Wave Jerks |
212 |
|
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... | Pendular Nystagmus; Oculopalatal Tremor |
213 |
|
Superior Canal Dehiscence | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 60-yo-man who complained of autophony (eg, hearing his own heartbeat, noting that his own voice sounded too loud) and dizziness triggered with loud noises and straining at times. With pinched-nose Valsalva maneu... | Nystagmus; Superior Canal Dehiscence; Valsalva |
214 |
|
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... | Superior Oblique Myokymia; Transient Monocular Oscillopsia; Vertical Diplopia |
215 |
|
Superior Oblique Myokymia - Three Patients with Recorded Attacks Using VOG and Frenzel Goggles | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 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... | Superior Oblique Myokymia; Fourth Troclear Nerve; Abnormal Alignment |
216 |
|
Supine Roll Test | Supine 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... | Supine Roll Test |
217 |
|
Test Your Knowledge - Acute Prolonged Vertigo | This 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 head ... | Abnormal Alignment; Jerk Nystagmus; Vestibular Nystagmus; Acute Vestibular Syndrome; Video Head Impulse Test |
218 |
|
Test Your Knowledge - Bilateral 4th Nerve Palsies | Watch 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 sulcus on ... | Abnormal Alignment; Fourth Nerve; Trochlear Nerve |
219 |
|
Test Your Knowledge - Central and Peripheral Vestibular and Ocular Motor Signs Due to a Large Vestibular Schwannoma | Which 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 distribution stroke A... | Abnormal VOR; Jerk Nystagmus; Vestibular Nystagmus; Gaze Evoked Nystagmus; Bruns Nystagmus; Cerebellar OMS |
220 |
|
Test Your Knowledge - Monocular Oscillopsia | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: Which 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... | Pendular Nystagmus |
221 |
|
Test Your Knowledge - Ocular Tilt Reaction and Subjective Visual Vertical | Lesions 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 |
222 |
|
Test Your Knowledge - Optokinetic Nystagmus with a Parietal Lesion | 𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: Given 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 fi... | Abnormal OKN; Jerk Nystagmus |
223 |
|
Test Your Knowledge - Oscillopsia | This 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 |
224 |
|
Test Your Knowledge - Parinaud's Syndrome in Neurosarcoidosis | Watch 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... | Normal Convergence; Vertical Gaze Palsy; Upgaze Palsy; Dorsal Midbrain; Mesencephalon; Convergence Retraction |
225 |
|
Test Your Knowledge - The Acute Vestibular Syndrome and Ptosis | What 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 lesion (stroke, M... | Jerk Nystagmus; Acute Vestibular Syndrome; Vestibular Nystagmus; Skew Deviation; Upbeat Nystagmus; Torsional Nystagmus; Rotary Nystagmus; Horner Syndrome |