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TitleDescriptionSubject
1 Bilateral INOs and partial 3rd nerve palsiesThis is a 45-year-old man with progressive ptosis and ophthalmoparesis. 10 years prior to presentation, he experienced diplopia and had a hyperintense lesion involving the medial longitudinal fasciculus (MLF) per report. Over time, he developed bilateral adduction paresis, ptosis and upgaze paresis ...Abnormal Range, Third Subnuclear, INO, Mesencephalon
2 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
3 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
4 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
5 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
6 Ocular motor & vestibular features of the MLF syndromeThis 61-year-old woman with HTN and DM presented for evaluation of acute onset diagonal diplopia. Adduction OS was about 60% of normal while medialization OS improved with convergence. In right gaze, dissociated abducting nystagmus was present OD, and there was a clear adduction lag when asking he...INO, Jerk Nystagmus, Torsional Nystagmus, Gaze-evoked Nystagmus
7 Ocular motor & vestibular features of the MLF syndrome - Figures 1, 2, and 3This 61-year-old woman with HTN and DM presented for evaluation of acute onset diagonal diplopia. Adduction OS was about 60% of normal while medialization OS improved with convergence. In right gaze, dissociated abducting nystagmus was present OD, and there was a clear adduction lag when asking he...INO, Jerk Nystagmus, Torsional Nystagmus, Gaze-evoked Nystagmus
8 Oculopalatal tremor and internuclear ophthalmoplegia due to hemorrhagic pontine cavernomaThis is a 60-year-old woman who experienced 2 episodes of vertigo, nausea and vomiting, which was felt to be related to recurrent hemorrhage of a pontine cavernoma that was adjacent to the fourth ventricle. The cavernoma was resected, and diplopia and left facial palsy were noted after the surgery. ...Pendular Nystagmus, Oculopalatal Tremor; INO; Pons OMS; Seventh Facial Nerve
9 Oculopalatal tremor and one-and-a-half syndrome due to pontine hemorrhageThis is a 65-year-old man who was put on a blood thinner, and shortly thereafter experienced a midline pontine hemorrhage, which was more dense on the left side. Immediately afterwards, right hemiparesis and hemi-anesthesia, left lower motor neuron (LMN) facial palsy and ophthalmoparesis were noted....Pendular Nystagmus; Oculopalatal Tremor; INO; One and a Half; Pons OMS; Seventh Facial Nerve; Sixth Abducens Nerve
10 One-and-a-half syndrome due to pontine hemorrhageThis is a 50-year-old woman who, while exercising in the gym, suddenly experienced vertigo, nausea, vomiting, tingling in the left arm, and diplopia. MRI demonstrated a brainstem hemorrhage that involved the right greater than left pons. Examination demonstrated a right horizontal gaze palsy due to ...Abnormal Saccades, Sixth Nerve Palsy, INO, One and a Half Syndrome, Jerk Nystagmus, Gaze Evoked Nystagmus
11 One-and-a-half syndrome, facial palsy, and nystagmus due to dorsal pontine demyelinationThis is a 16-yo-girl with oscillopsia and double vision. Exam showed inability to look to the left with either eye due to left nuclear 6th. There was also a left INO (horizontal gaze palsy + INO = one-and-a-half syndrome) from left MLF involvement and left lower motor neuron facial palsy due to fasc...One-and-a-half syndrome; Horizontal gaze palsy; Pons; Jerk nystagmus; Upbeat nysagmus; Facial nerve palsy; Internuclear ophthalmoplegia
12 Pendular, gaze-evoked and abducting nystagmus in MSThis is a 40-year-old woman with a history of multiple sclerosis who presented for oscillopsia. On examination, she had bilateral internuclear ophthalmoplegia (INO-adduction lag OU and abducting nystagmus OU), with a corresponding exotropia that increased in right and left gaze. She also had horiz...Jerk Nystagmus, INO, Pendular Nystagmus; Abducting Nystagmus, Gaze-Evoked Nystagmus, Cerebellar OMS
13 Pons: 6th and 7th nerve anatomy and the central tegmental tractFrom this cross-section of the pons, the proximity of the 6th nucleus to the 7th nerve fascicles is apparent. This is the basis of the so-called facial colliculus syndrome, where an ipsilesional horizontal gaze palsy from a nuclear 6th lesion (usually related to stroke or demyelination) can be seen ...Sixth Nerve Palsy, INO, One and a Half, Horizontal Gaze Palsy, OMS Pons, Facial Nerve, Oculopalatal
14 Pseudo-INOs in myasthenia gravisThis is a 55-yo-woman with an intermittent exotropia who had normal adduction OU, but clear lag of adducting saccades OD>OS with rapid horizontal saccades. This was much more apparent after repeat testing (ie, it was fatigable), and she wound up having ocular MG.Myasthenia Gravis, INO, Abnormal Saccades
15 Test Your Knowledge - OscillopsiaThis 65-year-old man with multiple sclerosis described that objects in front of him appear to spontaneously jump or move horizontally for the last few months. He reported that his symptoms occur independent of head movements and head impulse testing was normal. After viewing the video, what is the m...Pendular Nystagmus, Jerk Nystagmus, Abducting Nystagmus, Internuclear Ophthalmoplegia
16 Test Your Knowledge - Vertical-torsional nystagmusQuestion #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) nystagm...Jerk Nystagmus, Rotary Nystagmus, Upbeat Nystagmus, INO, Skew, Abnormal Alignment, Abnormal Saccades, Vestibular Nystagmus, Acute Vestibular Syndrome
17 Testing for adduction lag in partial INO using an optokinetic stimulusIn this patient we demonstrate the use of an optokinetic stimulus to elicit an internuclear ophthalmoplegia (INO). Occasionally adduction appears to be normal with an INO, and an adduction lag with horizontal saccades should be sought as a confirmatory sign. Optokinetic tape is an easy way to assess...INO, Jerk Nystagmus
18 Wall-eyed bilateral INO in caudal midbrain lesionThis is a 30-yo-woman with the relatively acute onset of diplopia. There was a large angle exotropia, very subtle lag of the adducting saccades OD>OS, suggestive of bilateral INOs. This was best seen with rapid horizontal saccades, and a lesion involving bilateral MLFs in the caudal midbrain was dem...INO, Abnormal Saccades, Jerk Nystagmus, Gaze Evoked Nystagmus
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