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1 Bilateral riMLF syndrome causing vertical saccadic palsy and loss of ipsitorsional fast phasesThis is a 60-year-old man who developed fatigue and diabetes insipidus about 12 months prior to this video, and MRI demonstrated hypothalamic enhancement at that time. Nine months prior to this video, he gradually noticed that he was unable to look down. Work-up for ischemic, infectious, inflammator...Midbrain OMS; Downgaze Palsy; Upgaze Palsy; Vertical Gaze Palsy; Abnormal Saccades; Normal Pursuit
2 Optokinetic NystagmusDuring the bedside evaluation of optokinetic nystagmus (OKN), the patient is instructed to look at each red (or white) square as it moves past. Because this is not a full-field visual stimuli, using an optokinetic flag mainly allows the examiner to quickly evaluate for right/left and up/down symmet...Optokinetic Nystagmus
3 PSP with Vertical Gaze Palsy, Abnormal Optokinetic Nystagmus and Inability to Suppress Blinking to LightThis is a 75-year-old woman with a diagnosis of progressive supranuclear palsy (PSP). Examination demonstrated vertical supranuclear gaze palsy (i.e., it could be overcome by the vertical vestibulo-ocular reflex [VOR]), saccadic smooth pursuit and VOR suppression (not shown), and hypometric and slow...Vertical Gaze Palsy; Abnormal Optokinetic Nystagmus; Abnormal Saccades
4 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 agraphia E. Le...Abnormal OKN; Jerk Nystagmus
5 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 fals...Abnormal Saccades; Normal Optokinetic; Abnormal Range; Vertical Gaze Palsy; Upgaze Palsy; Downgaze Palsy; Mesencephalon; Ocular Motor
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