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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 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
3 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
4 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
5 Bilateral Vestibular Loss With Gaze-Evoked Nystagmus and Saccadic Visually Enhanced VORThis is 55-year-old man with the subacute onset of head movement-induced oscillopsia and dizziness. He had a history of psoriatic arthritis. He had not used medications known to be vestibulo-toxic such as gentamicin. ; Salient findings on his examination included 1) bilateral vestibular loss (BVL) d...Jerk Nystagmus; Gaze-Evoked Nystagmus; Abnormal VOR-HIT; Eighth Nerve
6 Bruns Nystagmus (During Video-Oculography) Due to Vestibular SchwannomaA 25-year-old man with a history of right-sided hearing loss, headaches and imbalance was found to have a right vestibular schwannoma on MRI, and underwent a partial resection and radiotherapy. He denied symptoms of head movement dependent oscillopsia (i.e., suggestive of significant unilateral or b...Jerk Nystagmus, Gaze-Evoked Nystagmus, Vestbular Nystagmus, Eighth Cranial Nerve, Vestibulocochlear Nerve; Cerebellar OMS
7 Bruns Nystagmus Due o a Cerebellopontine Angle TumorThis is a 15-yo-girl who experienced headache and imbalance leading to an MRI which showed a left sided cerebellopontine angle (CPA) tumor. Because of involvement of the left brainstem/cerebellum (e.g., dysfunction of the neural integrator/gaze holding apparatus) by the CPA mass, there was left-beat...Jerk Nystagmus; Gaze Evoked Nystagmus; Vestibular Nystagmus
8 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
9 Cerebellar Ataxia, Neuropathy, & Vestibular Areflexia Syndrome (CANVAS): Impaired Visually-Enhanced VOR and Abnormal Head Impulse TestingA 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...VOR Abnormal, HIT Abnormal, Jerk Nystagmus, Gaze Evoked Nystagmus, Square Wave Jerks
10 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
11 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
12 Chronic progressive external ophthalmoplegia (CPEO) and cerebellar signsThis is a 60-yo-woman who initially presented with imbalance and ophthalmoparesis. Initially, there was mild horizontal gaze limitation with mild gaze-evoked nystagmus and slow saccades, and over the years, gait ataxia and dysarthria (mainly a scanning quality to her speech) developed, and her ophth...Abnormal Saccades, Abnormal Range, Horizontal Gaze Palsy, Gaze Evoked Nystagmus
13 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
14 Gaze-Evoked Nystagmus & Slow Saccades Due to Anti-GAD Antibodies in a Patient with Stiff Person SyndromeThis is a 70-year-old woman with a several year long history of imbalance and stiffness. Exam demonstrated axial and lower extremity stiffness, and ocular motor exam demonstrated gaze-evoked nystagmus (e.g., right-beating in right gaze, left-beating in left gaze, up-beating in up gaze), and mild to ...Jerk Nystagmus; Gaze-Evoked Nystagmus; Abnormal Saccades
15 Gaze-Evoked and Centripetal Nystagmus in Creutzfeldt-Jakob DiseaseThis is a 65-year-old woman who experienced a progressive cerebellopathy over several months. Initially, she presented with mild gait imbalance and positional vertigo, and there was only apogeotropic positional nystagmus (more pronounced in supine roll test compared to Dix-Hallpike) with a very slig...Jerk Nystagmus; Gaze-Evoked Nystagmus; Rebound Nystagmus
16 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
17 Gaze-evoked and rebound nystagmus in a cerebellar syndrome30-yo-man with the subacute onset of a cerebellar syndrome. After extensive evaluation and progression, it was thought that this represented an autoimmune process and there was some improvement with immunosuppression. He had a variety of cerebellar ocular motor findings, including gaze-evoked nystag...Jerk nystagmus; End-gaze nystagmus; Gaze-evoked nystagmus; Rebound nystagmus; Cerebellar pathology
18 Horizontal Gaze Palsy, Facial Nerve Palsy, and Nystagmus Due to Dorsal Pontine IschemiaPresented here are two patients with horizontal gaze and facial palsies due to stroke. The first patient is a 60-year-old man who presented with double vision and hemiparesis due to a right dorsal pontine ischemic stroke. His exam was significant for a right horizontal gaze palsy due to right 6th nu...One and half syndome; Horizontal gaze palsy; Pons; Jerk nystagmus; Upbeat nystagmus; Gaze evoked nystagmus; Facial nerve palsy; Internuclear ophthalmoplegia
19 INO in multiple sclerosisDescription: This video includes 3 patients each with a known history of MS found to have unilateral or bilateral INOs on their exam. In the first 2 patients, the INOs are relatively subtle with normal adduction. However, with rapid horizontal saccades, an adduction lag is apparent which is suggesti...Internuclear Ophthalmoplegia, Abnormal Saccades, Gaze Evoked Nystagmus
20 INOs in strokeThis video shows 3 patients with vascular risk factors who suffered strokes of the MLF resulting in unilateral INO in each case. In the second case, INO was diagnosed status post cardiac catherization and MRI was found to be normal. In the third case, the patient had a clear left medial rectus palsy...Internuclear Ophthalmoplegia, Abnormal Saccades, Gaze Evoked Nystagmus, Abducting Nystagmus
21 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
22 Medial medullary syndromesThis is a video of two patients who suffered small strokes involving the right medial medulla, and who presented with acute vertigo and oscillopsia. The first patient in the video had pure upbeat nystagmus, while the second patient had upbeat-torsional (towards the right ear) nystagmus in addition t...Medulla; Jerk Nystagmus; Upbeat Nystagmus; Gaze Evoked Nystagmus; Vestibular Nystagmus; Acute Vestibular
23 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
24 Neuro-Ophthalmic Features and Pseudo-MG Lid Signs in Miller Fisher SyndromeThis is a 51-year-old woman who presented with imbalance, acute onset dizziness and diplopia that developed over three days following two weeks of upper respiratory infection and bacterial conjunctivitis. When she was initially seen as an outpatient, nystagmus was noted to the right and left, and a ...Abnormal VOR; Miller Fisher Syndrome; Myasthenia Gravis; Acute Vestibular Syndrome; Jerk Nystagmus; Gaze Evoked Nystagmus
25 Neuro-Ophthalmic Features and Pseudo-MG Lid Signs in Miller Fisher Syndrome - Figure 1This is a 51-year-old woman who presented with imbalance, acute onset dizziness and diplopia that developed over three days following two weeks of upper respiratory infection and bacterial conjunctivitis. When she was initially seen as an outpatient, nystagmus was noted to the right and left, and a ...Abnormal VOR; Miller Fisher Syndrome; Myasthenia Gravis; Acute Vestibular Syndrome; Jerk Nystagmus; Gaze Evoked Nystagmus
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