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1 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
2 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
3 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
4 ConvergenceCan bring out or change the direction of vertical nystagmus in Wernicke's, or cerebellar disease; may be impaired in Parkinson's disease, head trauma, elderly patients; may overcome an adduction deficit with an INO. Instructional ocular motor examination procedures.Convergence; Exam; Abnormal Saccades
5 HINTS exam and saccadic dysmetria in lateral medullary strokeThis is a 50-year-old who experienced the abrupt onset of prolonged vertigo following chiropractic therapy 2 months prior. Initial work-up included an MRI and MR angiogram - MR-diffusion weighted imaging showed an acute left lateral medullary stroke and left vertebral artery occlusion, which was tho...Abnormal Saccades, Acute Vestibular Syndrome, Jerk Nystagmus, Vestibular Nystagmus, Normal VOR, Skew Deviation, OMS Medulla
6 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
7 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
8 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
9 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
10 Nystagmus due to paraneoplastic (anti-Yo) brainstem and cerebellar degenerationThis is a 40-yo-woman with anti-Yo antibody associated with ovarian cancer. Initial symptoms 2.5 years prior (to this video) included imbalance and dysarthria. She complained of oscillopsia which was due to her upbeat nystagmus (presumably the result of brainstem involvement), and diplopia (she had ...Abnormal Saccades, Abnormal VORS, Cerebellar, Jerk Nystagmus, Upbeat Nystagmus, Gaze Evoked Nystagmus,
11 Ocular motor signs in early progressive supranuclear palsyThis is a 64-year old man who experienced imbalance and falls (usually backwards) for the last 6 months. He experienced difficulty navigating stairs and had become a messy eater (thought to be in large part due to his vertical gaze palsy), and had developed hypophonia. Exam demonstrated square wave ...Abnormal Saccades, Abnormal Convergence, Abnormal Pursuit, Abnormal Range, Abnormal VORS, Vertical Gaze Palsy, Downgaze Palsy, OMS Mesencephalon
12 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
13 Parinaud's syndrome in a man with GBM of the pineal glandThis is a 60-yo-man who presented with diplopia, headaches, and difficulty looking up, and was found to have a mass involving the pineal gland. Biopsy was diagnostic of a GBM. Major features of Parinaud's (dorsal midbrain) syndrome were present including: upgaze palsy, convergence retraction nystagm...Saccades; Convergence; Range; Dorsal midbrain syndrome; Convergence retraction nystagmus; Upgaze palsy
14 Parinaud's syndrome with impaired upward saccades and otherwise normal vertical eye movementsThis is a 50-yo-man who suffered a dorsal midbrain stroke. Exam demonstrated normal vertical range of eye movements, normal vertical VOR and smooth pursuit, but inability to perform upward saccades. Another feature of Parinaud's syndrome seen on his exam was light-near dissociation (not shown in thi...abnormal saccades, range of eye movements, abnormal range of eye movements, smooth pursuit, normal VOR, Dorsal midbrain syndrome
15 Pendular nystagmus and ocular motor signs in MSThis is a 30-year-old man with a 15 year history of multiple sclerosis. For the last 12 months, he experienced horizontal oscillopsia. On examination, there were ocular motor abnormalities including gaze-evoked nystagmus, saccadic smooth pursuit, and hypermetric saccades which were attributable to h...Pendular Nystagmus, Jerk Nystagmus, Gaze Evoked Nystagmus, Abnormal Saccades
16 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
17 SaccadesThe examiner should note: conjugacy (a lag of the adducting eye may be seen with an INO); accuracy (posterior fossa lesions commonly produce dysmetria (overshooting or undershooting); velocity (if slow, may suggest a lesion of the burst neurons in the pons [PPRF - horizontally] or midbrain [riMLF - ...Saccades; Exam; Conjugacy; Abnormal saccades
18 Saccadic dysmetria and ocular lateropulsion in lateral medullary strokeThis is a 30-yo-man who suffered a right lateral medullary stroke. Examination showed saccadic hypermetria to the right (ipsilesional), hypometria to the left (contralesional)and rightward ocular lateropulsion (ipsilesional), common ocular motor features of the lateral medullary syndrome. Saccadic h...Lateral medullary syndrome, Wallenberg Syndrome, Saccadic dysmetria, Ocular lateropulsion, Saccades
19 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
20 Saccadic pathways in the brainstem and cerebellum & mechanism for saccadic dysmetria in Wallenberg syndrome - Abnormal function of the brainstem/cerebellar saccadic pathways with a left Wallenberg syndromeThe end result of a lesion involving the climbing fibers within the left lateral medulla is deficient rightward saccades (contralesional hypometric saccades), and over-active leftward saccades (ipsilesional hypermetric saccades), and ipsilesional ocular lateropulsion given this baseline imbalance. M...Medulla OMS, Normal Saccades, Abnormal Saccades, Figures
21 Saccadic pathways in the brainstem and cerebellum & mechanism for saccadic dysmetria in Wallenberg syndrome - Normal function of the brainstem/cerebellar saccadic pathwaysThe inferior cerebellar peduncle (ICP) carries climbing fibers to the dorsal vermis, and these fibers have an inhibitory influence over the Purkinje cells. These Purkinje cells normally inhibit the ipsilateral fastigial nucleus, and the fastigial nucleus projects to the contralateral inhibitory burs...Medulla OMS, Normal Saccades, Abnormal Saccades, Figures
22 Slow abducting saccade in 6th nerve palsy40-yo-man with a right fascicular 6th nerve palsy due to stroke. There was improvement and only a minimal residual right abduction paresis OD by this visit, but still a relatively slow right abducting saccade seen in the video, especially apparent in the slow motion segment. Video shows slow abduct...Sixth (Abducens) Nerve Palsy; Abnormal Saccades
23 Slow saccades due to unilateral paramedian pontine reticular formation (PPRF) injury with preserved movements using the vestibulo-ocular reflexThis is a 60-year-old man who presented for imbalance and oscillopsia 10 months after surgery and 8 months after radiation for Merkel cell carcinoma of the neck. He developed imbalance after surgery and diplopia and oscillopsia 6 months prior to our evaluation. MRI showed enhancement of both 6th n...Abnormal Saccades, Pons OMS, Sixth Abducens Nerve, Abnormal VOR, Vestibulocochlear Nerve, Horizontal Gaze Palsy
24 Slow volitional saccades and poor fast phases to an optokinetic stimulus, with preserved head impulse testingThis is a 67-year-old woman presenting with imbalance and binocular horizontal diplopia at near. On examination there were frequent square wave jerks, limited supraduction OU and convergence insufficiency, which explained her diplopia. Pursuit and suppression of the vestibulo-ocular reflex were sa...Abnormal Saccades, VOR HIT Normal
25 Square wave jerks and macrosaccadic oscillations in a patient with a cerebellar tumorThis is a 40-year-old man who developed severe headaches, confusion, and gait imbalance which led to neuroimaging which demonstrated a midline cerebellar mass with compression of the fourth ventricle and obstructive hydrocephalus. He underwent a suboccipital craniectomy for resection of the mass, an...Abnormal Saccades, Square Wave Jerks
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