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1 Daroff_01-1Introduction to Eye MovementsThis brief clip reveals how eye movements subserve vision, and provides an overview of each of the four eye movement systems: saccadic, smooth pursuit, vergence, and vestibular.Eye Movements; Saccades; Smooth pursuit; Cerebral control of eye movements; Efferent Visual Pathways; Convergence
2 Daroff_01-10Whipples Mimicking PSPA patient is shown with nuchal dystonic ridigity, profound retropulsion, limited range of horizontal saccades, an almost complete vertical gaze palsy, normal vestibulo-ocular eye movements, and apraxia of eyelid opening. His pendular convergence nystagmus was the clue that he had CNS Whipple's Dise...Whipple Disease; Progressive Supranuclear Palsy; Saccades; Whipple's Disease
3 Daroff_01-2Saccadic SystemThe anatomical pathways of saccades are described. These primarily involve the frontal eye fields (FEF), mesencephalic reticular nuclei, pontine paramedian reticular formation (PPRF), and cranial nerve nuclei III, IV, and VI. The three saccadic generators in the cortex are in the contralateral FEF...Saccades; Eye Movements; Saccadic System
4 Daroff_01-3Pursuit SystemThe anatomical pathways of smooth pursuit are described, stressing the importance of the cerebellum that, in contrast to the saccadic system, relays information between the cortex and brain stem. The outcomes of specific cortical lesions are discussed and the important concept of gain is introduced.Pursuit System
5 Daroff_01-4Defective PursuitA patient with a cerebral hemispherectomy manifests ipsilateral low-gain (saccadic) pursuit, and impaired optokinetic nystagmus when the targets are moved towards the lesioned side. The multiple causes of pursuit abnormalities are discussed.Eye Movement Disorders; Smooth Pursuit Deficiencies; Pursuit
6 Daroff_01-5Defective Saccades: Slow to No SaccadesIn this video, the many causes of this syndrome are listed, and a patient demonstrates the consequence of being unable to generate saccadic eye movements. On cold caloric stimulation, his eyes deviate tonically to the side of the stimulation without fast phases to the opposite side.Saccades; Saccadic Eye Movements; Eye Movement Disorders
7 Daroff_01-6Defective Saccades: Frontal Lobe LesionA patient with a right frontal lobe infarction demonstrates loss of saccades to the left with preservation of pursuit.Saccades; Saccadic Eye Movements; Eye Movement Disorders; Frontal Lobe Lesion
8 Daroff_01-7Normal Vertical Eye MovementsThe brain stem pathway for vertical saccades involves the PPRF, rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF), nucleus of Cajal, and the nuclei of cranial nerves III and IV. For upgaze, projections from the riMLF traverse through the posterior commissure, whereas there ...Normal Vertical Eye Movements; Vertical Saccades
9 Daroff_01-8Vertical Gaze ParalysisA patient is shown with up, down, and leftward gaze palsies as a result of a presumed right-sided high midbrain lesion. (He was encountered prior to the introduction of CT scanning, so that localization could not be verified). He had normal vestibulo-ocular reflexes. In addition, he had a curious ...Vertical Gaze Paralysis; Eye Movement Disorders
10 Daroff_01-9Progressive Supranuclear PalsyA patient with PSP demonstrates bilateral hypometric saccades, bilateral low-gain pursuit, vertical gaze palsy, and normal vestibulo- ocular reflexes. A second PSP patient is unable to make saccades or pursue horizontally. With optokinetic stimulation, the eyes move somewhat. Cold caloric stimula...Progressive Supranuclear Palsy; Saccades; Vertical Gaze Palsy
11 Daroff_02-1Parinaud's Syndrome or Dorsal Midbrain SyndromeAlso known as the pretectal, or sylvian aqueduct syndromes, it is characterized by paralysis of upgaze to both saccades and pursuit. In this video, the causes of Parinaud's, along with its signs of large pupils with light-near dissociation, spastic-paretic accommodation, pathologic lid retraction (...Parinaud Syndrome; Dorsal Midbrain Syndrome; Eye Movement Disorders; Convergence Retraction Nystagmus
12 Daroff_02-10Gaze Evoked Ear RetractionLarge ears normally retract during ipsilateral gaze, as shown in this segment. However, it won't be noted unless you look for it. "You see what you look for, and you look for what you know."Gaze Evoked Ear Retraction
13 Daroff_02-11Ocular Myasthenia GravisA man with limited ocular excursions and only small amplitude saccades, improves with Tensilon, this illustrates the need to always consider ocular myasthenia in the differential diagnosis in patients with limited eye movements. Rapid restricted saccades, as this patient demonstrates, are diagnosti...Ocular Myasthenia Gravis
14 Daroff_02-12Various Causes of OphthalmoplegiaAs a resident, I missed the diagnoses of Ocular-Myasthenia Wernicke's, and Thyroid Eye Disease. To remind myself to consider these etiologies, I developed the "3 T's: Tensilon, Thiamine, and Thyroid. As the years past, I added two more T's: Tropia and Trauma.Ophthalmoplegia; Decompensation of Phorias; Restriction Syndromes; Thyroid Eye Disease; Thyroid-Associated Ophthalmopathy; Blow-Out Fracture
15 Daroff_02-13Psychogenic Gaze PalsyPsychogenic Gaze-Palsy is unusual but can usually be detected during Oculo-cephalics when the eyebrows don't elevate during attempted upward gaze.Psychogenic Gaze Palsy; Eye Movement Disorders
16 Daroff_02-14Accomodative Gaze Palsy or Convergence SpasmThis is a psychogenic disorder that may mimic lateral rectus palsy. The clue is pupillary constriction during attempted lateral gaze.Accomodatitve Gaze Palsy; Convergence Spasm; Eye Movement Disorders; Spasm of the Near Triad
17 Daroff_02-2Horizontal Eye MovementsThe anatomic pathway involved in horizontal saccadic eye movements include the frontal eye fields, paramedian pontine reticular formation (PPRF), medial longitudinal fasciculus (MLF), and cranial nerve nuclei III and VI. The pathway for the vestibulo- ocular reflex (VOR) passes through the PPRF at ...Horizontal Eye Movements; Frontal Eye Fields; Paramedian Pontine Reticular Formation (PPRF); Medial Longitudinal Fasciculus (MLF); Oculomotor Cranial Nerves
18 Daroff_02-3Bilateral Horizontal Gaze PalsyA patient with a bilateral PPRF lesion displays intact vertical gaze and convergence.Bilateral Horizontal Gaze Palsy; Eye Movement Disorders; Horizontal Gaze Palsy
19 Daroff_02-4Internuclear OphthalmoplegiaLesions of the MLF cause an INO, which manifests as ipsilateral palsies of adduction, and nystagmus of the contralateral abducted eye. Vertical gaze is preserved. Inducing optokinetic nystagmus so that the adducting eye is responsible for the fast phase, causes a dissociation between the two eyes, a...Internuclear Ophthalmoplegia
20 Daroff_02-5Bilateral Internulcear OphthalmoplegiaA woman with a bilateral INO demonstrates impaired adduction and nystagmus of the abducting eyes. Her vertical gaze is intact. The dissociated optokinetic nystagmus, due to an inability of the medial recti to generate normal saccades, is again shown.Bilateral Internulcear Ophthalmoplegia; Nystagmus; Internuclear Ophthalmoplegia
21 Daroff_02-6Wall-Eyed Internuclear OphthalmoplegiaSome patients with bilateral INOs are exotropic. Convergence is variable; it may be completely normal in both eyes, absent bilaterally, or present in one eye only.Wall-Eyed Internuclear Ophthalmoplegia; Internuclear Ophthalmoplegia
22 Daroff_02-7Classifications of Internuclear OphthalmoplegiaBoth the Lutz and Cogan classifications of INO separate them into anterior and posterior varieties. The Cogan classification, which depends upon the presence or absence of convergence, is not particularly useful for localization. The Lutz posterior INO, which is a supranuclear pareses of abduction, ...Internuclear Ophthalmoplegia
23 Daroff_02-8One and Half SyndromeThis involves both gaze palsy secondary to a lesion of the ipsilateral PPRF or VI nucleus, and an INO secondary to a lesion of the MLF on the same side. If the VI nucleus is involved, VII palsy almost always occurs due to the proximity of the VII fascicle to the VI nucleus.One and Half Syndrome; Paralytic Pontine Exotropia
24 Daroff_02-9Gustatory Lid Retraction in Congenital Horner's SyndromeA young girl with unilateral ptosis from a congenital Horner's syndrome demonstrates a distinctively rare phenomenon of resolution of the ptosis by sucking lemon juice.Horner Syndrome; Lid Retraction
25 Daroff_03-1Cerebellar Eye Signs: OverviewThe wide array of cerebellar eye signs, includes, among others, saccadic intrusions and oscillations, nystagmus, gaze palsies, and impairment of the vestibulo-ocular reflex.Eye Movement Disorders; Cerebellar Eye Signs; Olivopontocerebellar Degeneration
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