The Robert B. Daroff Neuro-Ophthalmology Collection
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EHSL - Robert B. Daroff Collection
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    • This describes the observed increase in vestibular nystagmus with gaze in the direction of the fast phase, and its decrease with gaze in the slow phase direction.
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    • Brain stem anatomy and oculomotor physiology as it pertains to eye movement disorders is described as pertinent background for understanding cerebellar oscillations. Again the importance of the pulse-step firing and the cerebellum in the context...
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    • The role of the cerebellum in modifying the output of the neural integrator is discussed. Impaired integration causes jerk nystagmus with increasing or decreasing velocity exponential slow phases.
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    • Saccades depend on a pulse-step firing pattern that allows an initiation of the saccade (pulse), and maintenance of the new eye position in space (step). This video explains the anatomical pathway for this type of activation. The burst cells,...
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    • A woman with a bilateral INO demonstrates impaired adduction and nystagmus of the abducting eyes. Her vertical gaze is intact. The dissociated optokinetic nystagmus, due to an inability of the medial recti to generate normal saccades, is again...
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    • In this series, the importance of the brainstem in eye movements is discussed, with particular emphasis is placed on the signficance of the paramedian pontine reticular formation (PPRF), the medial longitudinal fasciculus (MLF), and the nuclei and...
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    • Lesions of the cerebellum can result in a variety of eye movement disorders, including saccadic intrusions and oscillations, such as ocular dysmetria, as well as nystagmus, gaze palsies, and dysfunction of the vestibular ocular reflex. In this...
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    • The wide array of cerebellar eye signs, includes, among others, saccadic intrusions and oscillations, nystagmus, gaze palsies, and impairment of the vestibulo-ocular reflex.
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    • In this series, the purpose and nomenclature of eye movements are described, with the anatomical pathways generating and controlling the cortically-driven movements –- saccades and smooth pursuit in horizontal gaze, upgaze and downgaze --...
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    • The eye movement disorders commonly accompanying Chiari malformations are listed. These are generally the same as with lesions of the cerebellum.
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    • Both the Lutz and Cogan classifications of INO separate them into anterior and posterior varieties. The Cogan classification, which depends upon the presence or absence of convergence, is not particularly useful for localization. The Lutz posterior...
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    • A patient with a cerebral hemispherectomy manifests ipsilateral low-gain (saccadic) pursuit, and impaired optokinetic nystagmus when the targets are moved towards the lesioned side. The multiple causes of pursuit abnormalities are discussed.
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    • In this video, the many causes of this syndrome are listed, and a patient demonstrates the consequence of being unable to generate saccadic eye movements. On cold caloric stimulation, his eyes deviate tonically to the side of the stimulation...
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    • Lid nystagmus is of three types. The most common is associated with vertical ocular nystagmus with the lid movement being synchronous with the eyes, but with greater aplitutde. The second type is associated with gaze evoked horizontal nystagmus...
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    • Large ears normally retract during ipsilateral gaze, as shown in this segment. However, it won’t be noted unless you look for it. “You see what you look for, and you look for what you know.”
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    • A young girl with unilateral ptosis from a congenital Horner’s syndrome demonstrates a distinctively rare phenomenon of resolution of the ptosis by sucking lemon juice.
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    • The anatomic pathway involved in horizontal saccadic eye movements include the frontal eye fields, paramedian pontine reticular formation (PPRF), medial longitudinal fasciculus (MLF), and cranial nerve nuclei III and VI. The pathway for the...
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    • Lesions of the MLF cause an INO, which manifests as ipsilateral palsies of adduction, and nystagmus of the contralateral abducted eye. Vertical gaze is preserved. Inducing optokinetic nystagmus so that the adducting eye is responsible for the fast...
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    • This brief clip reveals how eye movements subserve vision, and provides an overview of each of the four eye movement systems: saccadic, smooth pursuit, vergence, and vestibular.
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    • A woman with multiple sclerosis has a postural tremor and macro square wave jerks. These indicate a cerebellar outflow problem. Macro square wave jerks are somewhat of a misnomer since the eye movements are not entirely square; an alternate...
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    • In this final series, several eye movement abnormalities are detailed with patients used to illustrate each. KEY WORDS: opsoclonus-myoclonus, opsoclonus, square wave jerks, macro square wave jerks, pause cell dysfunction, voluntary nystagmus,...
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    • The brain stem pathway for vertical saccades involves the PPRF, rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF), nucleus of Cajal, and the nuclei of cranial nerves III and IV. For upgaze, projections from the riMLF...
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    • This is characterized by an initial fast phase downward, followed by a slow phase up, which is the reverse of nystagmus, where a corrective fast phase follows the slow phase. Most patients with bobbing have a large pontine lesion and are comatose...
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    • Upon attempted refixation, patients with this cerebellar eye sign over-shoot and oscillate, before eventually reaching their intended targets. Two patients demonstrate this disorder.
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    • A man with limited ocular excursions and only small amplitude saccades, improves with Tensilon, this illustrates the need to always consider ocular myasthenia in the differential diagnosis in patients with limited eye movements. Rapid restricted...
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    • The relevant anatomy of this disorder involves the inferior olivary nucleus, projecting via the restiform body to the contralateral dentate nucleus, traveling to the contralateral red nucleus via the superior cerebellar peduncle, and finally back...
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    • This involves both gaze palsy secondary to a lesion of the ipsilateral PPRF or VI nucleus, and an INO secondary to a lesion of the MLF on the same side. If the VI nucleus is involved, VII palsy almost always occurs due to the proximity of the VII...
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    • The differential diagnosis in adults is presented, followed by probably the most dramatic example of this disorder ever filmed. The father of American Neuro-ophthalmology, Dr. Frank Walsh, gave a copy of the film to Dr. J. Lawton Smith who, in...
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    • An infant with Infantile Opsoclonus-Myoclonus (“Dancing Eyes, Dancing Feet”), with a likely underlying neuroblastoma is shown and the differential diagnosis of opsoclonus in infants and children is listed.
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    • Also known as the pretectal, or sylvian aqueduct syndromes, it is characterized by paralysis of upgaze to both saccades and pursuit. In this video, the causes of Parinaud’s, along with its signs of large pupils with light-near dissociation,...
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    • Burst neurons are tonically inhibited by the pause neurons, which lie in the nucleus raphe interpositus. Lesions of the pause neurons result in ocular flutter.
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    • A patient with PSP demonstrates bilateral hypometric saccades, bilateral low-gain pursuit, vertical gaze palsy, and normal vestibulo- ocular reflexes. A second PSP patient is unable to make saccades or pursue horizontally. With optokinetic...
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    • Psychogenic Gaze-Palsy is unusual but can usually be detected during Oculo-cephalics when the eyebrows don’t elevate during attempted upward gaze.
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    • The anatomical pathways of smooth pursuit are described, stressing the importance of the cerebellum that, in contrast to the saccadic system, relays information between the cortex and brain stem. The outcomes of specific cortical lesions are...
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    • The anatomical pathways of saccades are described. These primarily involve the frontal eye fields (FEF), mesencephalic reticular nuclei, pontine paramedian reticular formation (PPRF), and cranial nerve nuclei III, IV, and VI. The three saccadic...
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    • Two patients with see-saw nystagmus are presented. The nystagmus is usually due to a suprasellar lesion associated with a bitemporal hemianopsia or a rostral midbrain lesion. The nystagmus is conjugate and torsional with a dissociated vertical...
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    • These are the most common ocular oscillations, since they occur in normals, particularly in the elderly and in many neurological disorders. They fall under a category called “saccades intrusions.” A man with very subtle square waves is...
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    • This eye movement abnormality presents with intermittent monocular oscillopsia, often following a particular eye movement or head tilt. The examiner will often miss the abnormality unless it can be provoked. It represents a microtremor of a...
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    • A female patient with upbeating nystagmus that increases in amplitude with upward gaze is shown. This type of nystagmus commonly occurs from a lesion involving one of three regions: the ponto-medullary junction, ponto-mesencephalic junction, and...
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    • As a resident, I missed the diagnoses of Ocular-Myasthenia Wernicke’s, and Thyroid Eye Disease. To remind myself to consider these etiologies, I developed the “3 T’s: Tensilon, Thiamine, and Thyroid. As the years past, I added two more...
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    • A patient is shown with up, down, and leftward gaze palsies as a result of a presumed right-sided high midbrain lesion. (He was encountered prior to the introduction of CT scanning, so that localization could not be verified). He had normal...
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    • In this video, a woman shows her ability to voluntarily induce an ocular oscillation. It is called “voluntary nystagmus”, although the oscillation consist of back-to-back saccades, such as occurs in ocular flutter. Clues to the voluntary...
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    • Some patients with bilateral INOs are exotropic. Convergence is variable; it may be completely normal in both eyes, absent bilaterally, or present in one eye only.
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    • A patient is shown with nuchal dystonic ridigity, profound retropulsion, limited range of horizontal saccades, an almost complete vertical gaze palsy, normal vestibulo-ocular eye movements, and apraxia of eyelid opening. His pendular convergence...
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