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TitleDescriptionSubject
1 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,
2 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
3 Impaired smooth pursuit and other characteristic ocular motor findings in middle cerebellar peduncle strokeThis is a 50-year-old woman who underwent resection of a left-sided acoustic neuroma, and post-operatively, she had vertigo, binocular diplopia, left hemi-ataxia and severe gait ataxia. MR diffusion weighted imaging demonstrated an acute stroke involving the left middle cerebellar peduncle (MCP) and...Abnormal Pursuit, VOR-HIT Abnormal, Abnormal Alignment, Vestibulocochlear Nerve, OMS Pons, Jerk Nystagmus, Gaze-Evoked Nystagmus, Bruns Nystagmus, Vestibular Nystagmus, Acute Vestibular Syndrome
4 Ocular motor signs in early progressive supranuclear palsyThis is a 64-year old man who experienced imbalance and falls (usually backwards) for the last 6 months. He experienced difficulty navigating stairs and had become a messy eater (thought to be in large part due to his vertical gaze palsy), and had developed hypophonia. Exam demonstrated square wave ...Abnormal Saccades, Abnormal Convergence, Abnormal Pursuit, Abnormal Range, Abnormal VORS, Vertical Gaze Palsy, Downgaze Palsy, OMS Mesencephalon
5 Ocular motor signs in progressive supranuclear palsy (PSP)This is a 65-yo-woman complaining of imbalance and double vision. She had significant convergence insufficiency (and would close her right eye with near viewing), providing an explanation for her diplopia. Convergence insufficiency is very common with parkinsonism. She had bradykinesia and rigidity,...Abnormal Pursuit, Abnormal Range, Upgaze Palsy, Downgaze Palsy, Mesencephalon, Square Wave Jerks
6 Parinaud's syndrome with impaired upward saccades and otherwise normal vertical eye movementsThis is a 50-yo-man who suffered a dorsal midbrain stroke. Exam demonstrated normal vertical range of eye movements, normal vertical VOR and smooth pursuit, but inability to perform upward saccades. Another feature of Parinaud's syndrome seen on his exam was light-near dissociation (not shown in thi...abnormal saccades, range of eye movements, abnormal range of eye movements, smooth pursuit, normal VOR, Dorsal midbrain syndrome
7 Saccadic smooth pursuit and vestibulo-ocular reflex suppression (VORS)This is a 20-yo-man who suffered a left MCA stroke years prior. Upon evaluation of his eye movements, saccades and all classes of eye movements were normal, although his smooth pursuit and VORS were choppy to the left (ipsilesional) and normal to the right. When pursuit and VORS (which are usually e...Smooth pursuit; Vestibulo-ocular reflex (VOR) supression
8 Smooth PursuitA 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 lesionsPursuit, Exam
9 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
10 riMLF Syndrome from Artery of Percheron StrokeThis is a 65-yo-man who suffered the abrupt onset of loss of consciousness followed by difficulty looking down. MRI showed bilateral rostral midbrain strokes in the distribution of the artery of Percheron. He could not initiate downward saccades and had fair upward saccades. However, downward vestib...Saccades abnormal; Vestibulo-ocular reflex and head impulse testing normal; Pursuit normal; Vertical gaze palsy; Downgaze palsy; Mesencephalon
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