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1 Acquired Elliptical Pendular Nystagmus Suppressed by Blinks and SaccadesThis is a 70-year-old man who experienced the gradual onset of oscillopsia over weeks about 3 months prior to this video recording. Examination demonstrated elliptical pendular nystagmus which was atypical for infantile nystagmus or oculopalatal tremor (no palatal tremor on exam). The remainder of t...Pendular Nystagmus
2 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
3 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
4 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
5 Test Your Knowledge - Vertical Saccadic Palsy Due to Bilateral riMLF InfarctionsThis is a 30-year-old who was found minimally responsive on the lounge floor of an ice skating rink. He was brought to the ED, where he had a GCS score of 8 (where 15 is normal) for poor responsiveness. His ocular motor exam is shown in the video. Regarding Finding #1, which of the following is fals...Abnormal Saccades; Normal Optokinetic; Abnormal Range; Vertical Gaze Palsy; Upgaze Palsy; Downgaze Palsy; Mesencephalon; Ocular Motor
6 Upbeat Nystagmus & Ocular Flutter Due to Cerebellar Pilocytic AstrocytomaThis is a 20-year-old woman who was diagnosed with a cerebellar pilocytic astrocytoma at age 10 after presenting with severe headaches and hydrocephalus. She underwent incomplete resection and radiation therapy at that time. She experienced mild vertical oscillopsia in upgaze at baseline, and increa...Upbeat Nystagmus; Ocular Flutter
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