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TitleDescriptionSubject
1 + HIT, + Skew, Unidirectional Nystagmus: Central acute vestibular syndrome due to Wallenberg syndromeThis is a 45-year-old woman who presented to the ED with acute prolonged vertigo and vertical diplopia. She was seen as an outpatient 1 month after her ED visit, and double vision and balance were improving by that time. Her HINTS testing showed the following (seen in the video):; 1); Head Impulse -...VOR HIT Abnormal, Abnormal Alignment, Skew, Jerk Nystagmus, Vestibular Nystagmus, Acute Vestibular Nystagmus
2 Anterior canal BPPVAlthough the anterior canal (AC) variant of benign paroxysmal positional vertigo (BPPV) is rare, mainly owing to its orientation relative to gravity (which makes otoconial debris much less likely to enter it), it can occur. Because of the relatively para-sagittal orientation of the AC (more so than ...BPPV Anterior, BPPV Diagnosis, Jerk Nystagmus, Vestibular Nystagmus
3 Bruns nystagmus due to 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
4 Central Acute Vestibular Syndrome due to posterior fossa hemorrhageThis is a patient presenting with the acute vestibular syndrome (AVS, e.g., acute prolonged vertigo, spontaneous nystagmus) whose HINTS (Head Impulse, Nystagmus, Test of Skew) testing indicated a central etiology based on negative (normal) head impulse testing (HIT). Nystagmus was unidirectional and...VOR HIT, Alignment, Jerk Nystagmus, Vestibular Nystagmus, Acute Vestibular
5 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
6 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
7 Dix-Hallpike maneuver in posterior BPPV with reversal of nystagmus on sitting upThis is a patient with typical posterior canal (PC) benign paroxysmal positional vertigo (BPPV), which is provoked by the Dix-Hallpike maneuver. When the patient is moved into the right Dix-Hallpike maneuver, after a brief latency, upbeat-torsional (towards the lowermost or affected [right] ear) nys...BPPV Posterior, BPPV Diagnosis, Jerk Nystagmus, Vestibular Nystagmus
8 Downbeat nystagmusThis is a 40-year-old man with 2 years of progressive ataxia and oscillopsia. On examination, he had downbeat nystagmus (DBN), an ocular motor finding that is usually (but not always) associated with flocculus/paraflocculus dysfunction, which causes overaction of the anterior canal (upward or anti-g...Downbeat Nystagmus, OMS Cerebellar, Jerk Nystagmus, Vestibular Nystagmus
9 Downbeat nystagmus and cerebellar atrophyThis is a 40-year-old man with 2 years of progressive ataxia and oscillopsia. On examination, he had downbeat nystagmus (DBN), an ocular motor finding that is usually (but not always) associated with flocculus/paraflocculus dysfunction, which causes overaction of the anterior canal (upward or anti-g...Downbeat Nystagmus, OMS Cerebellar, Jerk Nystagmus, Vestibular Nystagmus
10 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
11 Head-Shaking-Induced Nystagmus Following Ramsay Hunt VestibulopathyThis is a 50-year-old man who experienced the abrupt onset of imbalance, dizziness and left-sided hearing loss 4 months prior to this examination. He was found to have herpetic vesicles in the left external auditory canal and diagnosed with Ramsay Hunt syndrome. On exam (4 months after the onset), t...Vestibular Nystagmus; Head-Shaking; Jerk Nystagmus; Vestibularcochlear; Acute Vestibular Syndrome
12 Head-shaking nystagmus - a "central" patternEvaluating for nystagmus provoked by head-shaking, so-called head-shaking nystagmus (HSN), should be performed in all patients with complaints of dizziness or vertigo, regardless of the chronicity. The maneuver is performed by passively moving the head horizontally (can also be performed vertically)...Abnormal Head Shaking, Jerk Nystagmus, Vestibular Nystagmus
13 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
14 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
15 Peripheral (vestibular) and central (gaze-evoked) patterns of nystagmus in a single patientA 55-year-old man experienced episodic vertigo and was diagnosed with Meniere's disease affecting the left ear (based on audiograms and his clinical course) about 1 year prior to presentation. About 6 months prior to presentation, intratympanic (IT) gentamicin was injected into the left ear, at whic...Jerk Nystagmus, Vestibular Nystagmus, Bruns, Gaze Evoked Nystagmus, VOR HIT Abnormal
16 Posterior canal BPPV pre- and post-Epley maneuverThis is a patient with typical right posterior canal benign paroxysmal positional vertigo (BPPV), which was provoked by the Dix-Hallpike maneuver. When the patient was moved into the right Dix-Hallpike maneuver, after a brief latency, upbeat-torsional (towards the lowermost or affected [right] ear) ...BPPV Posterior, BPPV Diagnosis, BPPV Treatment, Jerk Nystagmus, Vestibular Nystagmus,
17 Posterior canal BPPV treated with Semont maneuverThis is a patient with left posterior canal (PC) benign paroxysmal positional vertigo (BPPV), and upbeat-torsional (towards the left ear) nystagmus was provoked by left Dix-Hallpike maneuver and left side-lying maneuver. This video demonstrates treatment of her left PC BPPV with the Semont maneuver....BPPV Posterior, BPPV Diagnosis, BPPV Treatment, Jerk Nystagmus, Vestibular Nystagmus
18 Posterior canal BPPV with fixation and with fixation removedThis is a 60-yo-woman with positional vertigo. In the right Dix-Hallpike position with fixation removed, there was clear upbeat-torsional nystagmus (towards the lowermost right ear) which led to the diagnosis of right posterior canal BPPV. In right Dix-Hallpike with fixation there was mainly torsion...Benign Paroxysmal Positional Vertigo; BPPV, Dix-Hallpike, posterior canal; Vestibular nystagmus; Jerk nystagmus
19 Pseudo-spontaneous nystagmus and bow and lean test in horizontal canal BPPVThis is a 70-year-old woman presenting to the Emergency Department with positional vertigo that was determined to be due to the apogeotropic variant of right horizontal canal (HC) benign paroxysmal positional vertigo (BPPV). When her head is in a neutral position with the head in axis with the trunk...Benign Paroxysmal Positional Vertigo; BPPV; Horizontal Canal; Jerk nystagmus; Vestibular nystagmus; Head shaking
20 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
21 Superior Canal DehiscenceThis is a 60-yo-man who complained of autophony (eg, hearing his own heartbeat, noting that his own voice sounded too loud) and dizziness triggered with loud noises and straining at times. With pinched-nose Valsalva maneuver, there was downbeat-torsional (towards the right ear) nystagmus, suggestive...Nystagmus; Superior canal dehiscence; Valsalva
22 Test Your Knowledge - Acute prolonged vertigoThis is a 60-year old man with diabetes presenting with acute onset prolonged vertigo that was ongoing at the time of this examination. Which of the following statements are true with regard to the localization and/or etiology of this patient's symptoms? ; A.; Whether or not symptoms worsen with he...Abnormal Alignment, Jerk Nystagmus, Vestibular Nystagmus, Acute Vestibular Syndrome, Video Head Impulse Test
23 Test Your Knowledge - Central and peripheral vestibular and ocular motor signs due to a large vestibular schwannomaWhich of the following is least likely to be the correct localization or etiology given the findings seen in the video? ; 1); Acute right 8th cranial neuropathy ; 2); Right-sided vestibular schwannoma; 3); Right vestibular nucleus infarction ; 4); Right anterior inferior cerebellar artery distributi...Abnormal VOR, Jerk Nystagmus, Vestibular Nystagmus, Gaze Evoked Nystagmus, Bruns Nystagmus, Cerebellar OMS,
24 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 l...Jerk Nystagmus, Acute Vestibular Syndrome, Vestibular Nystagmus, Skew Deviation, Upbeat Nystagmus, Torsional Nystagmus, Rotary Nystagmus, Horner Syndrome
25 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
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