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1 + 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
2 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
3 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
4 Central HINTS (With an Abnormal Head Impulse Sign) in the Acute Vestibular Syndrome Due to Lateral Pontine/Middle Cerebellar Peduncle DemyelinationThis is a 30-year-old man presenting with vertigo, diplopia and mild left facial weakness (not seen in the video). On exam, there was right-beating nystagmus (RBN) in primary gaze that increased in right gaze (in accordance with Alexander's law), and the RBN stayed unidirectional, but lessened, in l...Abnormal Alignment; Vestibulocochlear; OMS Pons; Rotary Nystagmus; Vestibular Nystagmus; Acute Vestibular Nystagmus; Jerk Nystagmus; VOR HIT Abnormal
5 Convergence Insufficiency and Square Wave Jerks in PSPThis is a 70-yo-woman with progressive supranuclear palsy with complaints of difficulty reading. Her husband noticed that she would frequently close one eye when attempting to read, and words were not clear on the page, and this would in fact improve by covering one eye. On her exam, she had a 1 pri...Convergence; Alignment; Convergence Insufficiency; Square Wave Jerks
6 Divergence insufficiency in cerebellar ataxiaThis is a 65-yo woman with complaints of imbalance (progressive over years) and horizontal diplopia at distance. On her exam, there was a small symptomatic esotropia at distance, but only a small esophoria at near. There were no obvious abduction deficits, and the 6 prism diopter ET at distance was...Abnormal Alignment, Divergence Insufficiency, OMS Cerebellar
7 Eye signs in infantile esotropia - latent nystagmus and inferior oblique overactionThis is a 25-yo-man with a history of amblyopia and intermittent eye crossing. On exam, he had a comitant 25 prism diopter esotropia, and other features of infantile (or congenital) esotropia including: latent nystagmus (right-beating nystagmus with occlusion of the left eye and left-beating nystagm...Jerk Nystagmus, Latent Nystagmus, Abnormal Range, Assessing Abnormal Alignment
8 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
9 Latent nystagmus and DVD in infantile esotropiaThis is a 20-year-old woman with infantile esotropia (s/p strabismus surgery as a child) who demonstrated latent nystagmus and presumed dissociated vertical deviation (DVD) OS, which are commonly seen with infantile esotropia (also inferior oblique overaction and monocular nasotemporal asymmetry to ...Alignment abnormal; Jerk nystagmus; Latent nystagmus
10 Maddox Rod and Red Glass TestingDescribing the basics of strabismus.Strabismus; Alignment Normal; Alignment Abnormal
11 Medial Longitudinal Fasciculus Syndrome with Prominent Spontaneous NystagmusThis is a 60-year-old man who experienced the abrupt onset of diplopia and imbalance. He had typical features of a left medial longitudinal fasciculus (MLF) syndrome including left internuclear ophthalmoplegia (INO) and left hypertropia from skew deviation, but he also had very prominent upbeat-tors...INO; Jerk Nystagmus; Upbeat Nystagmus; Rotary Nystagmus; Skew Deviation; OMS Pons; Abnormal Alignment; Abducting Nystagmus
12 Mesodiencephalic Stroke Causing Unilateral riMLF and INC Ocular Motor SyndromesThis is a 65-year-old man who experienced the sudden onset of diplopia (with horizontal and vertical components), dysarthria and imbalance. An MRI performed the following day showed a left mesodiencephalic stroke. The patient was seen in clinic 10 days later (when the video was taken), and by that t...Abnormal Saccades; Abnormal Alignment; Mesencephalon; Jerk Nystagmus; Torsional Nystagmus
13 Mild 6th Nerve Palsy Due to Pontine StrokeThis is a 70-year-old woman with HTN and diabetes who presented with horizontal diplopia for several weeks, worse in right gaze. There was a very subtle abduction paresis OD with full motility elsewhere. With cover-uncover testing, there was a small esotropia in right gaze (esodeviation seen with al...Abnormal Alignment; Abnormal Range; Sixth Nerve Palsy
14 Paroxysmal Ocular Tilt ReactionThis is a 60-year-old woman who 2 years prior experienced a left sided hypertensive hemorrhagic stroke, resulting in right hemiparesis, dysarthria and vertical diplopia. The initial vertical diplopia resolved completely and about 6 months following the hemorrhage the patient began to experience many...Midbrain OMS; Skew Deviation; Jerk Nystagmus; Abnormal Alignment
15 Sagging Eye Syndrome and Cerebellar Disease in Divergence InsufficiencyThis is a 70-year-old woman who presented with diplopia at distance. Her exam demonstrated orthophoria at near with a fairly comitant 8-10 PD esotropia at distance without abduction paresis, consistent with divergence insufficiency (DI). With age, patients may develop an esodeviation greater at dist...Abnormal Alignment; OMS Cerebellar; Jerk Nystagmus; Gaze Evoked Nystagmus; Divergence Insufficiency
16 Sequelae of cerebellar hemorrhage - gaze-evoked nystagmus, alternating skew deviation and palatal tremorThis is a 75-yo-woman presenting with a gait disorder. Two years prior, she suffered a cerebellar hemorrhage. On examination, there were typical cerebellar ocular motor signs including gaze-evoked nystagmus, choppy smooth pursuit and VOR suppression, and saccadic dysmetria. There was also an alterna...Assessing Abnormal Alignment, Jerk Nystagmus, Gaze Evoked Nystagmus, Oculopalatal Myoclonus
17 Skew Deviation and Spontaneous Nystagmus Due to Posterior Fossa LesionsThis is a 50-year-old woman who reported the abrupt onset of imbalance, right upper extremity incoordination and binocular vertical diplopia several months prior to her presentation to our clinic. On examination, she had a left hypertropia that was fairly comitant (measuring 5 prism diopters) assoc...Abnormal Alignment; Jerk Nystagmus; Upbeat Nystagmus; Vestibular Nystagmus; Rotary Nystagmus; Skew Deviation
18 Spontaneous Torsional Nystagmus and Ocular Tilt ReactionThis 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 experienced intermittent vertical diplopia. MRI done months after the onset was unrem...Jerk Nystagmus, Rotary Nystagmus; Abnormal Alignment
19 Superior Oblique Myokymia - Three Patients with Recorded Attacks Using VOG and Frenzel GogglesPatients 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 depression, respectively). In many cases, SOM represents a neurovascular compression ...Superior Oblique Myokymia; Fourth Troclear Nerve; Abnormal Alignment
20 Test Your Knowledge - Acute Prolonged VertigoThis 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
21 Test Your Knowledge - Bilateral 4th Nerve PalsiesWatch 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
22 Test Your Knowledge - Vertical-Torsional VystagmusQuestion #1: Watch the first portion of the video until you are told to stop. Is this vestibular nystagmus more likely to be peripheral or central? A. Peripheral B. Central Answer for #1: A. Incorrect. While the patient has upbeat-torsional (top poles beating toward the right ear) nystagmus which is...Jerk Nystagmus; Rotary Nystagmus; Upbeat Nystagmus; INO; Skew; Abnormal Alignment; Abnormal Saccades; Vestibular Nystagmus; Acute Vestibular Syndrome
23 The acute vestibular syndrome with skew deviation, gaze-evoked nystagmus, and bilaterally abnormal head impulse testing due to AICA strokeThis is a 60-year-old man with the acute onset of prolonged vertigo and nystagmus, consistent with the acute vestibular syndrome (AVS). HINTS (Head Impulse, Nystagmus, Test of Skew) exam demonstrated a central pattern: 1) Head impulse test (HIT) was abnormal to the right and to the left. An abnormal...Abnormal VOR-HIT, Abnormal Alignment, Skew, Jerk Nystagmus, Gaze Evoked Nystagmus, Acute Vestibular Syndrome, Seventh Nerve, OMS Pons, OMS Cerebellar
24 Vertical Vergence and Fusional AmplitudeEssential information on vertical fusional vergences.Normal Alignment; Abnormal Alignment; Fourth Nerve Palsy; Vergence; Fusional Amplitudes
25 Vestibular Neuritis with a Peripheral Skew DeviationThis is a 55-year-old hypertensive man who developed acute onset continuous vertigo and presented to the Emergency Department (ED) after several hours of symptoms. He was noted to have spontaneous nystagmus and had a normal brain MRI within the first 24 hours. The first portion of the video was rec...Abnormal VOR; Abnormal Alignment; Eighth Nerve; Skew Deviation; Lateropulsion; Jerk Nystagmus; Vestibular Nystagmus; Acute Vestibular Syndrome
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