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TitleDescriptionSubject
1 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
2 Central Positional Vertigo and Nystagmus in a Posterior Fossa TumorThis is a 30-year old woman who presented with positional vertigo and vomiting following a concussion related to a car accident 3 months prior. She was initially diagnosed with posterior canal (PC) benign paroxysmal positional vertigo (BPPV), although there was no improvement with Epley maneuvers. T...Vestibular Nystagmus, Jerk Nystagmus, Gaze-Evoked Nystagmus, Central Positional Nystagmus, Cerebellar OMS, Downbeat Nystagmus, Upbeat Nystagmus
3 Cerebellar degeneration with downbeat nystagmus provoked by convergenceDescription: This is a 70-yo-woman with a progressive gait disorder, diagnosed with cerebellar ataxia. She displayed typical cerebellar ocular motor signs including gaze-evoked nystagmus, choppy pursuit and VOR suppression, and there was very subtle spontaneous downbeat nystagmus, best appreciated w...Convergence Abnormal, Cerebellar pathology, Jerk nystagmus, Downbeat nystagmus
4 Cerebellar eye signs in SCA8This is a 30-yo-man with a diagnosis of SCA 8 who had appendicular and gait ataxia in addition to choppy smooth pursuit and VORS, downbeat nystagmus, saccadic hypermetria, and gaze-evoked nystagmus with rebound nystagmus. He also had an esotropia worse at distance, which is commonly found with cereb...Saccadic dysmetria; Downbeat nystagmus; Gaze-evoked nystagmus; Vestibulo-ocular reflex (VOR) supression; Saccades
5 Chiari Malformation Causing Downbeat Nystagmus in Lateral GazeThis is a 20-yo-man who presented with oscillopsia in lateral gaze from downbeat nystagmus (DBN). In primary gaze, very subtle DBN was only noted with ophthalmoscopy, but in lateral gaze, prominent DBN was present. Other central ocular motor signs included gaze-evoked nystagmus (GEN) vertically, in ...Jerk Nystagmus; Gaze Evoked Nystagmus; Downbeat Nystagmus
6 Downbeat (Perverted) Head Shaking Nystagmus in a Patient with Spontaneous Torsional NystagmusThis is a 75-year-old woman with vascular risk factors who experienced abrupt onset imbalance and dizziness. Symptoms were maximal at onset, and she denied progression over 6 months. Clinically, it was felt that she had suffered a stroke, although an MRI one months later demonstrated an unremarkable...Torsional Nystagmus; Jerk Nystagmus; Headshaking; Downbeat Nystagmus; Cerebellar Pathology
7 Downbeat NystagmusThis is a 40-year-old man with 2 years of progressive ataxia and oscillopsia. On examination, he had downbeat nystagmus (DBN), an ocular motor finding that is usually (but not always) associated with flocculus/paraflocculus dysfunction, which causes overaction of the anterior canal (upward or anti-g...Downbeat Nystagmus; OMS Cerebellar; Jerk Nystagmus; Vestibular Nystagmus
8 Downbeat Nystagmus and Cerebellar AtrophyThis is a 40-year-old man with 2 years of progressive ataxia and oscillopsia. On examination, he had downbeat nystagmus (DBN), an ocular motor finding that is usually (but not always) associated with flocculus/paraflocculus dysfunction, which causes overaction of the anterior canal (upward or anti-g...Downbeat Nystagmus; OMS Cerebellar; Jerk Nystagmus; Vestibular Nystagmus
9 Downbeat Nystagmus with Active Horizontal Head ShakingThis is a 70-year-old man who presented with one single complaint for 10 years - if he moved his head too quickly (even one single horizontal head movement to the right or the left), he would experience the abrupt loss of balance and dizziness. His typical episodes were reproducible, and interesting...Downbeat Nystagmus; Jerk Nystagmus; OMS Cerebellar; Abnormal Headshaking; Gaze-Evoked Nystagmus
10 Downbeat nystagmus and convergence spasmThis is a 60-yo-woman with vertical oscillopsia related to her downbeat nystagmus, and diplopia related to an intermittent esotropia. When the esotropia was present, with versions there were bilateral abduction deficits. With ductions and the vestibulo-ocular reflex, it was apparent that the range o...Convergence-abnormal, Range-abnormal, Sixth nerve palsy, Convergence spasm, Cerebellar pathology, Jerk nystagmus, Downbeat nystagmus
11 Gaze-Evoked, Rebound, and Centripetal Nystagmus in Cerebellar DegenerationA 68-year-old female reported a 2-year history of progressive gait imbalance, falls, dizziness and vertical oscillopsia. She described that dizziness and oscillopsia were worst when looking down. There was no family history of ataxia. Composite gaze with fixation was recorded with video-oculography ...Gaze-evoked Nystagmus; Rebound Nystagmus; Centripetal Nystagmus; Cerebellar Degeneration
12 Hyperventilation-Induced Downbeat Nystagmus in a Cerebellar DisorderThis is a 45-year-old woman with a chronic progressive cerebellopathy of unclear etiology (worsening over at least 10 years) characterized by gait and limb ataxia, gaze-evoked nystagmus, saccadic pursuit and vestibulo-ocular reflex suppression, an esotropia greater at distance, along with very mild ...Hyperventilation; Jerk Nystagmus; Downbeat Nystagmus; Downbeat Nystagmus; Cerebellar Pathology
13 Idiopathic downbeat nystagmus exacerbated with positional maneuversThis is a 45-yo-woman with vertical oscillopsia for 6+ months, found to have downbeat nystagmus on examination. She mainly complained of dizziness and oscillopsia when laying down. She was found to have a significant exacerbation in her baseline downbeat nystagmus with straight head hanging, and in ...Downbeat nystagmus, Jerk nystagmus, Central positional nystagmus
14 Idiopathic downbeat nystagmus exacerbated with positional maneuvers - Part 2: patient is now on 4-aminopyridineThis is a 45-yo-woman presented in "Idiopathic downbeat nystagmus exacerbated with positional maneuvers". This video was taken after the patient had been on 4-aminopyridine for 3 months. There was marked improvement in subjective oscillopsia and objective downbeat nystagmus. The strong positional co...Downbeat nystagmus, Jerk nystagmus, Central positional nystagmus
15 Idiopathic downbeat nystagmus, decreasing with convergenceThis is a 25-yo-woman who experienced vertically oscillopsia for 1 year, and was found to have downbeat nystagmus. Interestingly, there were no other cerebellar ocular motor signs - e.g., normal saccades, smooth pursuit, VOR suppression, and no gaze-evoked nystagmus, although her (pure) downbeat was...Convergence-Abnormal, Cerebellar Pathology, Downbeat nystagmus, Jerk nystagmus
16 Monocular downbeat nystagmus due to a posterior fossa cystThis is a 40-yo-man who experienced months of imbalance and was found to have an epidermoid cyst (immediately posterior to the 4th ventricle), which was resected. Months after surgery, he experienced monocular vertical oscillopsia. On examination, there was subtle downbeat nystagmus (DBN) in the rig...Downbeat Nystagmus, Jerk Nystagmus, Gaze Evoked Nystagmus, Abnormal Saccades
17 Ocular Motor Signs in SCA 6This is a 45-yo-man who was recently diagnosed with SCA 6. There was no clear spontaneous downbeat nystagmus (DBN) in primary gaze, although DBN could clearly be provoked by convergence. Other ocular motor features included choppy pursuit and VOR suppression horizontally and vertically, in addition ...Abnormal Convergence; Abnormal VORS; OMS Cerebellar; Downbeat Nystagmus; Jerk Nystagmus; Gaze Evoked Nystagmus; Rebound Nystagmus
18 Paraflocculus (Tonsillar) Ocular Motor Syndrome and Dysmetria in a Chiari Malformation - Pre and Post-Operative ExamsThis is a 25-year-old woman presenting with 6 months or progressive imbalance, binocular vertical diplopia, and occipital headaches, which were brought on or aggravated by coughing or sneezing. Examination demonstrated hyperreflexia in the arms and legs with sustained clonus at the ankles and Babins...Saccades; Skew Diviation; VOR Supression; Pursuit; Medulla
19 Paraneoplastic Downbeat Nystagmus and Cerebellar Ataxia Due to Small Cell Lung CarcinomaThis is a 61-year-old woman (non-smoker) who developed a gait disorder, dizziness and oscillopsia that was progressive over 2 months. Exam demonstrated spontaneous downbeat nystagmus with side pocket nystagmus in lateral gaze (a combination of horizontal gaze-evoked and downbeat nystagmus, giving an...Jerk Nystagmus; Downbeat Nystagmus; Cerebellar Ataxia; Carcinoma
20 Positional Nystagmus During an Attack of Vestibular MigraineA 50-year-old woman presented to clinic after experiencing multiple episodes of hours-long vertigo attacks that were associated with headache, photophobia and phonophobia. She had a history of motion sickness and migraine headaches in her teenage years. She was diagnosed with vestibular migraine. Sh...Central Positional Nystagmus; Downbeat Nystagmus; Rotary Nystagmus; Jerk Nystagmus
21 Positional downbeat nystagmus mimicking anterior canal BPPVAlthough positional downbeat nystagmus (pDBN) can indicate the rare anterior canal variant of benign paroxysmal positional vertigo, central mimics are common causes of pDBN. pDBN may be seen in multiple system atrophy (MSA), or seen with posterior fossa lesions, with a common example being a stroke ...Cerebellar, Jerk Nystagmus, Downbeat Nystagmus, Central Positional Nystagmus
22 Reversal of Vertical Nystagmus with Convergence in Anti-DPPX EncephalitisThis is a man who initially presented with spontaneous upbeat and torsional nystagmus, which led to the diagnosis of anti-DPPX encephalitis (for further details on this patient's course and for a video of his nystagmus, see reference 1). Over 6-12 months, his spontaneous (mainly) upbeat nystagmus (U...Upbeat Nystagmus; Downbeat Nystagmus; Jerk Nystagmus; Gaze-Evoked Nystagmus
23 Superior Canal DehiscenceThis is a 60-yo-man who complained of autophony (eg, hearing his own heartbeat, noting that his own voice sounded too loud) and dizziness triggered with loud noises and straining at times. With pinched-nose Valsalva maneuver, there was downbeat-torsional (towards the right ear) nystagmus, suggestive...Nystagmus; Superior canal dehiscence; Valsalva
24 Unilateral 3rd, 4th, and 6th nerve palsies due to cavernous sinus meningiomaThis is a 50-year-old woman presenting with a partial 3rd nerve palsy (mild pupil involvement), partial 6th nerve palsy, and no clear incyclotorsion with downgaze, suggestive of additional 4th nerve palsy, all on the left. With compressive lesions involving the 3rd nerve, often aberrant regeneration...Abnormal Range, Third Nerve Palsy, Aberrant Regeneration, Fourth Nerve Palsy, Sixth Nerve Palsy, Jerk Nystagmus, Downbeat Nystagmus, Gaze Evoked Nystagmus, Abnormal Saccades
25 Upbeat and downbeat nystagmus due to anti-VGCC antibodiesSeen here are two patients who presented with imbalance and vertical oscillopsia, the first with upbeat nystagmus, and the second with downbeat nystagmus. Both patients were found to have voltage-gated calcium channel antibodies in serum without evidence of systemic malignancy. The UBN patient had m...Jerk Nystagmus, Upbeat Nystagmus, Gaze Evoked Nystagmus, Downbeat Nystagmus
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