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1 Central (Nuclear) 3rd Nerve PalsiesShown here are two patients with left sided midbrain pathology (hemorrhage and ischemia) which caused damage to the 3rd nucleus. Both of the patients have ipsilateral mydriasis, adduction, supra- and infraduction paresis. Ipsilateral>contralateral ptosis is also present, and localizes to the central...Range of eye movements/motility abnormal; Third nuclear; Upgaze palsy; Downgaze palsy; Mesencephalon; Jerk nystagmus; Rotary nystagmus
2 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
3 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
4 Lateral pontine stroke involving the superior vestibular nucleus causing spontaneous upbeat-torsional nystagmusA 65-year-old man presented to the emergency department with spontaneous vertigo and unsteadiness, and had was noted to have spontaneous upbeat nystagmus (UBN), also with a torsional component (top poles beating toward the right ear) that was most noticeable in right and up gaze. General neurologic ...Jerk Nystagmus; Upbeat Nystagmus; Torsional Nystagmus; Pons; Acute Vestibular Syndrome
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 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
7 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
8 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
9 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
10 Saccadic Hypermetria and Ipsipulsion (Behind Closed Eyelids and with Vertical Saccades)This is a 40-year-old woman who experienced oscillopsia and vertical diplopia, due to spontaneous torsional nystagmus and a skew deviation (right hypotropia), respectively. The symptom onset was 7 months prior to these videos. MRI demonstrated ill-defined T2 and FLAIR hyperintensity signal changes i...Jerk Nystagmus; Torsional Nystagmus; Saccades; Lateropulsion; Medulla
11 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
12 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
13 Test Your Knowledge - The Acute Vestibular Syndrome and PtosisWhat is the most likely localization in this patient presenting with vertical diplopia and acute onset prolonged vertigo? A. Right medial longitudinal fasciculus (MLF) B. Left medial longitudinal fasciculus C. Right medulla D. Left medulla E. Left midbrain A. Incorrect. A right MLF lesion (stroke, M...Jerk Nystagmus; Acute Vestibular Syndrome; Vestibular Nystagmus; Skew Deviation; Upbeat Nystagmus; Torsional Nystagmus; Rotary Nystagmus; Horner Syndrome
14 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
15 Torsional Jerk NystagmusPresented here are 3 patients with torsional jerk nystagmus. The first patient presented with vertigo and experienced oscillopsia due to her torsional nystagmus. Pure or predominantly torsional nystagmus is highly suggestive of a central process. Her nystagmus was unidirectional and followed Alexand...Medulla; Cerebellar; Jerk nystagmus; Rotary nystagmus
16 Torsional Nystagmus Due to Medullary Pilocytic AstrocytomaThis is a 30-year-old woman who experienced headaches which led to an MRI and the diagnosis of a right medullary pilocytic astrocytoma, confirmed pathologically. Examination was performed a year after the initial diagnosis, and several months prior to this exam oscillopsia was experienced for the fi...Jerk Nystagmus; Rotary Nystagmus; OMS Medulla
17 Unidirectional nystagmus in lateral medullary syndromeThis is a 70-yo-man who presented with acute vertigo. Examination demonstrated very mild spontaneous torsional nystagmus (towards the right ear) in primary (not seen well in this video), with robust downbeat-torsional (towards right ear) nystagmus in right gaze and (less robust) almost pure torsiona...Medula, Rotary Nystagmus, Jerk Nystagmus, Acute Vestibula, Vestibular Nystagmus, Abnormal Saccades
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