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1 "Pseudonystagmus" Due to Bilateral Vestibular Loss and Head TremorThis is a 65-yo-woman with complaints of imbalance, dizziness, and horizontal oscillopsia. On exam, she had a high frequency, low amplitude (mainly horizontal) head tremor, and with ophthalmoscopy, the optic nerve was clearly oscillating back and forth at the same frequency as her head tremor, which...Abnormal VOR HIT
2 + HIT, + Skew, Unidirectional Nystagmus: Central Acute Vestibular Syndrome Due to Wallenberg SyndromeThis is a 45-year-old woman who presented to the ED with acute prolonged vertigo and vertical diplopia. She was seen as an outpatient 1 month after her ED visit, and double vision and balance were improving by that time. Her HINTS testing showed the following (seen in the video): 1) Head Impulse - A...VOR HIT Abnormal; Abnormal Alignment; Skew; Jerk Nystagmus; Vestibular Nystagmus; Acute Vestibular Nystagmus
3 3rd Nerve Palsy With Preserved 4th Nerve Function80-yo-woman with a left vasculopathic 3rd nerve palsy (minimal pupil involvement of about 1 mm relative mydriasis OS - other etiologies ruled out and resolved as expected over months). Although the inferior rectus is paretic, intact superior oblique muscle function can be demonstrated by asking the ...Third (Oculomotor) Nerve Palsy; Third subnuclear
4 6th nerve palsy as initial presentation of metastatic lung cancerA video describing 6th nerve palsy as initial presentation of metastatic lung cancer.Sixth Nerve Palsy; Lung Cancer; Metastatic Cancer
5 A 'Canal Jam' During Head Impulse Testing in a Patient With Horizontal Canal BPPVA 70-year-old man reported brief episodes of positional vertigo. Ten years prior, he had undergone gamma knife radiosurgery for a vestibular schwannoma at the left cerebellopontine angle. Video head impulse testing (vHIT) showed reduced gains and corrective saccades in the planes of the left horizon...Jerk Nystagmus; PC BPPV; HC BPPV Diagnosis; Vestibular Nystagmus; Eighth Cranial Nerve; Vestibulocochlear Nerve
6 A Comparison of Nystagmus and Saccadic Intrusions/OscillationsNystagmus can be classified into pendular and jerk waveforms, where both are generated by a slow, pathologic phase. Corrective phase (the position reset mechanism) differs. In pendular nystagmus, the eyes move back and forth with about the same velocity and amplitude, similar to that of a pendulum...Jerk Nystagmus; Flutter; Pendular Nystagmus; Square Wave Jerks; Opsoclonus,
7 Aberrant Regeneration of the 3rd NerveAberrant regeneration in two patients: 1) a young woman with a right cavernous sinus meningioma with subsequent development of aberrant regeneration demonstrated by eyelid elevation OD in attempted downgaze (i.e., some fibers that were supposed to innervate the right IR were misrouted to the right l...Third (Oculomotor) Nerve Palsy; Third Aberrant
8 Abnormal Active Head Impulse Testing Recorded Asynchronously in Bilateral Vestibular LossThis is a video of patient with the subacute onset of head movement-dependent oscillopsia due to bilateral vestibular loss (with obvious bilaterally abnormal head impulse test (HIT) at the bedside), in addition to central ocular motor signs including saccadic smooth pursuit and gaze-evoked nystagmus...Vestibulo-Ocular Reflex; Head Impulse Testing
9 Abnormal Head Impulse Test in Vestibular Neuritis 1 Week After OnsetThis is a 25-year-old woman who experienced the acute vestibular syndrome due to right-sided vestibular neuritis 1 week prior to this video. Left-beating nystagmus (LBN) was only noted in left gaze, but with fixation-removed, there was clear LBN in primary position that increased with head-shaking a...Abnormal VOR; Vestibulocochlear Nerve; Acute Vestibular Sydrome
10 Abnormal Visually-Enhanced VOR in Cerebellar Ataxia, Neuropathy, Vestibular Areflexia Syndrome (CANVAS)A 67 year old woman presented with 1 year of progressive numbness, gait instability, and oscillopsia when walking or with head movements. Examination showed excessive square-wave jerks, bilateral horizontal gaze-evoked nystagmus, impairment of the visually-enhanced vestibular ocular reflex (vVOR - s...Abnormal Pursuit; Abnormal VOR; Abnormal HIT; Cerebellar; Jerk Nystagmus; Gaze Evoked Nystagmus
11 Acquired Elliptical Pendular Nystagmus Suppressed by Blinks and SaccadesThis is a 70-year-old man who experienced the gradual onset of oscillopsia over weeks about 3 months prior to this video recording. Examination demonstrated elliptical pendular nystagmus which was atypical for infantile nystagmus or oculopalatal tremor (no palatal tremor on exam). The remainder of t...Pendular Nystagmus
12 Acute Vestibular Neuritis With Unidirectional Nystagmus and Abnormal Video Head Impulse TestThis is 45-year-old man who presented to the emergency department (ED) 2 days prior to this video recording with acute onset prolonged vertigo, nausea, head motion intolerance, unsteadiness and spontaneous nystagmus, consistent with the acute vestibular syndrome. Video-oculography examination in the...Jerk Nystagmus; Acute Vestibular Syndrome; Vestibular Nystagmus; Eighth Nerve; Abnormal VOR-HIT
13 Acute Vestibular Syndrome With Skew Deviation and Positive Head Impulse Test Due to a Demyelinating LesionThis 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...VOR HIT; Alignment; Acute Vestibular
14 Alternating Hypertropias - Bilateral 4th Nerve Palsies and Alternating Skew DeviationSeen here are two patients with alternating hypertropias. The first is a 70-year-old woman with a diagnosis of cerebellar ataxia, neuropathy, vestibular areflexia syndrome (CANVAS). In the video, both spontaneous downbeat nystagmus (DBN) and gaze-evoked nystagmus (GEN) are apparent, in addition to a...Skew Deviation; Alignment; Fourth Nerve Palsy; Cerebellar Pathology; Jerk Nystagmus; Downbeat Nystagmus; Gaze Evoked Nystagmus
15 Anterior Canal - BPPV: Deep Head HangingRegardless 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 position • Then the patient is moved into a supine position with the head in at l...Benign Paroxysmal Positional Vertigo; BPPV; Anterior Canal; Deep head hanging; Exam; Examination
16 Anterior Canal BPPVAlthough the anterior canal (AC) variant of benign paroxysmal positional vertigo (BPPV) is rare, mainly owing to its orientation relative to gravity (which makes otoconial debris much less likely to enter it), it can occur. Because of the relatively para-sagittal orientation of the AC (more so than ...BPPV Anterior; BPPV Diagnosis; Jerk Nystagmus; Vestibular Nystagmus
17 Anti-GAD Associated Cerebellopathy and Bilateral VestibulopathyThis is a 70-year-old woman with the subacute onset of severe imbalance and dizziness. On her initial examination, she had prominent gaze-evoked nystagmus and bilateral vestibular loss. Smooth pursuit was saccadic, although her vestibulo-ocular reflex (VOR) suppression was much smoother. Usually pur...Abnormal Pursuit; Normal VORS; VOR Abnormal; HIT Abnormal; Jerk Nystagmus; Gaze Evoked Nystagmus
18 Approach to the Ocular Motor and Vestibular History and ExaminationHistory and examination of ocular motor and vestibular.Saccades; Ocular Stability; Vestibular Examination
19 Apraclonidine testing in Horner's syndromeThis patient experienced relatively abrupt ptosis and was seen and diagnosed with a Horner's syndrome within a few days of the onset. There were no other exam findings and history did not offer clues as to the etiology. Neuroimaging of the oculosympathetic tract was unrevealing. Apraclonidine testin...Horner's Syndrome
20 Assessing for hyperventilation-induced nystagmusHyperventilation induced nystagmus is tested by asking the patient to take quick deep breaths (~1/s) for 40-60 seconds. This decreases ICP and increases CSF pH. This can be helpful in diagnosing irritative conditions of the vestibular nerve, including an acoustic neuroma (see video, https://collect...Hyperventilation
21 Atypical ocular motor features (gaze-evoked nystagmus) in PSPThis is a 70-yo-woman who met clinical and radiologic diagnostic criteria for progressive supranuclear palsy (PSP). Typical ocular motor features of PSP include square wave jerks, hypometric saccades, choppy pursuit/VORS, impaired down>upgaze (supranuclear in origin) and impaired down>upward saccade...Abnormal Saccades; OMS Cerebellar; Jerk Nystagmus; Upbeat Nystagmus; Gaze Evoked Nystagmus
22 AudiometryAudiometry is the measurement of the sensitivity and range of an individual's hearing. As many etiologies of imbalance, nystagmus, vertigo and/or dizziness can have an otologic origin the audiogram is an important piece of information in the evaluation of the dizzy patient. A basic audiogram (Fig. 1...Auditory Testing; Audiometry
23 Bilateral 6th nerve palsies due to idiopathic intracranial hypertensionThis is a 25-year-old woman who presented with diplopia and blurry vision. On exam, she was found to have papilledema and bilateral 6th nerve palsies. Her opening pressure was >40 cm of water with a normal CSF analysis, and neuroimaging was unremarkable aside from subtle findings that have been asso...Sixth Nerve Palsy; Abnormal Range
24 Bilateral Horizontal Gaze Palsy and Oculopalatal Tremor Due to Pontine HemorrhageThis 70-yo-woman experienced headache and diplopia and was found to have a hemorrhage centrally within the dorsal pons. Months after the onset, the patient was seen in clinic and had no horizontal eye movements (pursuit, saccades, VOR) in either eye, suggestive of bilateral nuclear 6th nerve palsies...VOR HIT Abnormal, Horizontal Gaze Palsy, OMS PONS, Pendular Nystagmus, Oculopalatal
25 Bilateral INOs Due to StrokeThis is a 65-year-old man with multiple vascular risk factors who experienced the abrupt onset of diplopia 6 months prior to this video. MRI done within 24 hours of onset was unremarkable. Examination demonstrated subtle bilateral adduction lag with horizontal saccades. There was very mild abducting...Abnormal Saccades; Abnormal Range
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