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1 Image/MovingImage+ 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 - A...VOR HIT Abnormal; Abnormal Alignment; Skew; Jerk Nystagmus; Vestibular Nystagmus; Acute Vestibular NystagmusNeuro-Ophthalmology Virtual Education Library: Dan Gold Neuro-Ophthalmology Collection: https://novel.utah.edu/Gold/
2 Image/MovingImageAbnormal Head Impulse Test in Vestibular Neuritis 1 Week After OnsetThis is a 25-year-old woman who experienced the acute vestibular syndrome due to right-sided vestibular neuritis 1 week prior to this video. Left-beating nystagmus (LBN) was only noted in left gaze, but with fixation-removed, there was clear LBN in primary position that increased with head-shaking a...Abnormal VOR; Vestibulocochlear Nerve; Acute Vestibular SydromeNeuro-Ophthalmology Virtual Education Library: Dan Gold Neuro-Ophthalmology Collection: https://novel.utah.edu/Gold/
3 Image/MovingImageAcute Vestibular Neuritis With Unidirectional Nystagmus and Abnormal Video Head Impulse Test𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is 45-year-old man who presented to the emergency department (ED) 2 days prior to this video recording with acute onset prolonged vertigo, nausea, head motion intolerance, unsteadiness and spontaneous nystagmus, cons...Jerk Nystagmus; Acute Vestibular Syndrome; Vestibular Nystagmus; Eighth Nerve; Abnormal VOR-HITNeuro-Ophthalmology Virtual Education Library: Dan Gold Neuro-Ophthalmology Collection: https://novel.utah.edu/Gold/
4 Image/MovingImageAcute Vestibular Syndrome With Skew Deviation and Positive Head Impulse Test Due to a Demyelinating LesionThis is a patient who initially presented with the acute vestibular syndrome (AVS, e.g., acute prolonged vertigo, spontaneous nystagmus). ; See https://collections.lib.utah.edu/details?id=187730 for additional history. ; Her HINTS (Head Impulse, Nystagmus, Test of Skew) testing indicated a central e...VOR HIT; Alignment; Acute VestibularNeuro-Ophthalmology Virtual Education Library: Dan Gold Neuro-Ophthalmology Collection: https://novel.utah.edu/Gold/
5 Image/MovingImageAcute Vestibular Syndrome with Ocular Tilt Reaction Due to Bacterial LabyrinthitisThis is a patient who initially presented with the acute vestibular syndrome (AVS, e.g., acute prolonged vertigo, spontaneous nystagmus) and right sided hearing loss, and was diagnosed with bacterial labyrinthritis. Her HINTS (Head Impulse, Nystagmus, Test of Skew) testing indicated a central etiolo...VOR HIT; Alignment; Jerk Nystagmus; Vestibular Nystagmus; Acute VestibularNeuro-Ophthalmology Virtual Education Library: Dan Gold Neuro-Ophthalmology Collection: https://novel.utah.edu/Gold/
6 Image/MovingImageAssessing Utricle Pathway Function and the Effects of Convergence on Nystagmus in Acute Vestibular NeuritisA 35-year-old woman presented a few days after the onset of room-spinning vertigo. She denied diplopia, dysarthria, dysphagia, dysphonia, incoordination, numbness, and weakness. On examination, she had subtle spontaneous right-beat nystagmus (RBN). This nystagmus increased in amplitude and frequency...Vestibular Nystagmus; Jerk Nystagmus; Acute Vestibular Syndrome; Eighth Nerve; Abnormal VHITNeuro-Ophthalmology Virtual Education Library: Dan Gold Neuro-Ophthalmology Collection: https://novel.utah.edu/Gold/
7 Image/MovingImageCentral 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 VestibularNeuro-Ophthalmology Virtual Education Library: Dan Gold Neuro-Ophthalmology Collection: https://novel.utah.edu/Gold/
8 Image/MovingImageCentral HINTS (With an Abnormal Head Impulse Sign) in the Acute Vestibular Syndrome Due to Lateral Pontine/Middle Cerebellar Peduncle Demyelination𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This 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 accordan...Abnormal Alignment; Vestibulocochlear; OMS Pons; Rotary Nystagmus; Vestibular Nystagmus; Acute Vestibular Nystagmus; Jerk Nystagmus; VOR HIT AbnormalNeuro-Ophthalmology Virtual Education Library: Dan Gold Neuro-Ophthalmology Collection: https://novel.utah.edu/Gold/
9 Image/MovingImageDemonstration of HINTS Examination in a Normal SubjectIn the acute vestibular syndrome - consisting of acute prolonged vertigo, spontaneous nystagmus, imbalance, nausea/vomiting, head motion intolerance which is typically due to vestibular neuritis or posterior fossa stroke - a 3 step test of ocular motor and vestibular function known as HINTS, has hig...Acute Vestibular; Normal VOR; Vertigo; HINTS examinationNeuro-Ophthalmology Virtual Education Library: Dan Gold Neuro-Ophthalmology Collection: https://novel.utah.edu/Gold/
10 Image/MovingImageHINTS Exam and Saccadic Dysmetria in Lateral Medullary Stroke𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This 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 l...Abnormal Saccades; Acute Vestibular Syndrome; Jerk Nystagmus; Vestibular Nystagmus; Normal VOR; Skew Deviation; OMS MedullaNeuro-Ophthalmology Virtual Education Library: Dan Gold Neuro-Ophthalmology Collection: https://novel.utah.edu/Gold/
11 Image/MovingImageNeuro-Ophthalmic Features and Pseudo-MG Lid Signs in Miller Fisher Syndrome𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 51-year-old woman who presented with imbalance, acute onset dizziness and diplopia that developed over three days following two weeks of upper respiratory infection and bacterial conjunctivitis. When she was ini...Abnormal VOR; Miller Fisher Syndrome; Myasthenia Gravis; Acute Vestibular Syndrome; Jerk Nystagmus; Gaze Evoked NystagmusNeuro-Ophthalmology Virtual Education Library: Dan Gold Neuro-Ophthalmology Collection: https://novel.utah.edu/Gold/
12 Image/MovingImageTest 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 head ...Abnormal Alignment; Jerk Nystagmus; Vestibular Nystagmus; Acute Vestibular Syndrome; Video Head Impulse TestNeuro-Ophthalmology Virtual Education Library: Dan Gold Neuro-Ophthalmology Collection: https://novel.utah.edu/Gold/
13 Image/MovingImageTest Your Knowledge: The Acute Vestibular Syndrome with Gaze-Evoked Nystagmus and Bilaterally Abnormal Head Impulse Testing Due to Middle Cerebellar Peduncle and Flocculus HemorrhageThis is a 70-year-old woman with a history of atrial fibrillation on warfarin presenting with acute prolonged vertigo and imbalance. In addition to the findings demonstrated in the first part of the video, what else should be seen to reassure the examiner that the etiology of her vertigo is benign? ...Abnormal VOR; Jerk Nystagmus; Acute Vestibular Syndrome; Cerebellar OMS; Gaze Evoked NystagmusNeuro-Ophthalmology Virtual Education Library: Dan Gold Neuro-Ophthalmology Collection: https://novel.utah.edu/Gold/
14 Image/MovingImageThe Acute Vestibular Syndrome with Skew Deviation, Gaze-evoked Nystagmus, and Bilaterally Abnormal Head Impulse Testing Due to AICA StrokeThis is a 60-year-old man with the acute onset of prolonged vertigo and nystagmus, consistent with the acute vestibular syndrome (AVS). HINTS (Head Impulse, Nystagmus, Test of Skew) exam demonstrated a central pattern: 1) Head impulse test (HIT) was abnormal to the right and to the left. An abnormal...Abnormal VOR-HIT; Abnormal Alignment; Skew; Jerk Nystagmus; Gaze Evoked Nystagmus; Acute Vestibular Syndrome; Seventh Nerve; OMS Pons; OMS CerebellarNeuro-Ophthalmology Virtual Education Library: Dan Gold Neuro-Ophthalmology Collection: https://novel.utah.edu/Gold/
15 Image/MovingImageThe Episodic Vestibular SyndromeThis is a 55-year-old man with 6 months of episodic vertigo without clear triggers/provocative factors, with each of his 3 previous episodes lasting less than 5 minutes. While in the clinic, he had one of his typical vertigo attacks. There was initially 30 seconds of right-beating-torsional nystagmu...Jerk Nystagmus; Acute Vestibular SyndromeNeuro-Ophthalmology Virtual Education Library: Dan Gold Neuro-Ophthalmology Collection: https://novel.utah.edu/Gold/
16 Image/MovingImageUsing Video Head Impulse Testing to Unmask Covert Saccades in Compensated Vestibular VeuritisThis is a 30-year-old woman who experienced the acute vestibular syndrome (prolonged vertigo for >24 hours, nausea, unsteadiness, spontaneous nystagmus, head motion intolerance) and was diagnosed with vestibular neuritis. This diagnosis was based on a positive head impulse test to the left (see Figu...VOR Normal; VOR AbnormalNeuro-Ophthalmology Virtual Education Library: Dan Gold Neuro-Ophthalmology Collection: https://novel.utah.edu/Gold/
17 Image/MovingImageVestibular Neuritis with + Head Impulse Test and Unidirectional NystagmusVestibular neuritis is the most common cause of the acute vestibular syndrome, which is characterized by continuous vertigo and spontaneous nystagmus lasting days. It may be mimicked by central causes, including stroke, but in the hands of subspecialists, the HINTS+ (Head Impulse, Nystagmus, Test o...Jerk Nystagmus; Acute Vestibular; Vestibular NystagmusNeuro-Ophthalmology Virtual Education Library: Dan Gold Neuro-Ophthalmology Collection: https://novel.utah.edu/Gold/
18 Image/MovingImageVibration-Induced Nystagmus in a Patient with Vestibular Neuritis𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: This is a 60-year-old man who experienced the sudden onset of vertigo, oscillopsia, imbalance, nausea and vomiting. He was seen in the emergency department within hours and had spontaneous right-beating (RBN) and torsiona...Jerk Nystagmus; Vestibular Nystagmus; Eighth Cranial Nerve; Acute Vestibular SyndromeNeuro-Ophthalmology Virtual Education Library: Dan Gold Neuro-Ophthalmology Collection: https://novel.utah.edu/Gold/
19 Image/MovingImageWallenberg Syndrome in MS𝗢𝗿𝗶𝗴𝗶𝗻𝗮𝗹 𝗗𝗲𝘀𝗰𝗿𝗶𝗽𝘁𝗶𝗼𝗻: 30-yo-woman with MS presenting with acute vertigo and vertical diplopia. Examination demonstrated several aspects of the Wallenberg syndrome (her acute demyelinating lesion was in the left lateral medulla): ipsilesional (...Vestibulo-ocular Reflex; Head Impulse Testing; Abnormal Alignment; Lateropulsion; Wallenberg Syndrome; Medulla; Vestibular Nystagmus; Skew DeviationNeuro-Ophthalmology Virtual Education Library: Dan Gold Neuro-Ophthalmology Collection: https://novel.utah.edu/Gold/
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