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The Robert B. Daroff Neuro-Ophthalmology Collection
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Browsing items in: EHSL - Robert B. Daroff Collection

(54 results)

Display: 100

    • Accomodative Gaze Palsy or Convergence Spasm

    • Daroff_02-14
    • This is a psychogenic disorder that may mimic lateral rectus palsy. The clue is pupillary constriction during attempted lateral gaze.
    • Accomodatitve Gaze Palsy; Convergence Spasm; Eye Movement Disorders; Spasm of the Near Triad
    • Alexander's Law

    • Daroff_03-7
    • 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.
    • Alexander's Law; Vestibular Ocular System; Vestibular Nystagmus
    • Anatomy and Physiology of Nystagmus

    • Daroff_03-12
    • 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.
    • Nystagmus
    • Anatomy and Physiology of the Saccade System

    • Daroff_03-11
    • 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,...
    • Saccades; Saccadic Eye Movements; Supranuclear Input
    • Bilateral Horizontal Gaze Palsy

    • Daroff_02-3
    • A patient with a bilateral PPRF lesion displays intact vertical gaze and convergence.
    • Bilateral Horizontal Gaze Palsy; Eye Movement Disorders; Horizontal Gaze Palsy
    • Bilateral Internulcear Ophthalmoplegia

    • Daroff_02-5
    • 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...
    • Bilateral Internulcear Ophthalmoplegia; Nystagmus; Internuclear Ophthalmoplegia
    • Brain Stem Eye Movement Syndromes

    • Daroff_Tape-2
    • 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...
    • Brain Stem; Eye Movement Disorders;
    • Cerebellar Eye Signs

    • Daroff_Tape-3
    • 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...
    • Cerebellar; Eye Movement Disorders; Cerebellar Pathology
    • Cerebellar Eye Signs: Overview

    • Daroff_03-1
    • The wide array of cerebellar eye signs, includes, among others, saccadic intrusions and oscillations, nystagmus, gaze palsies, and impairment of the vestibulo-ocular reflex.
    • Eye Movement Disorders; Cerebellar Eye Signs; Olivopontocerebellar Degeneration;
    • Cerebral Control of Eye Movements

    • Daroff_Tape-1
    • 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 --...
    • Cerebellar; Eye Movement disorders; Supranuclear Input; Optokinetic Nystagmus
    • Chiari Malformation: Eye Movements

    • Daroff_03-5
    • The eye movement disorders commonly accompanying Chiari malformations are listed. These are generally the same as with lesions of the cerebellum.
    • Arnold-Chiari Malformation; Eye Movement Disorders; Chiari Malformation
    • Classifications of Internuclear Ophthalmoplegia

    • Daroff_02-7
    • 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...
    • Internuclear Ophthalmoplegia
    • Defective Pursuit

    • Daroff_01-4
    • 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.
    • Eye Movement Disorders; Smooth Pursuit Deficiencies; Pursuit
    • Defective Saccades: Frontal Lobe Lesion

    • Daroff_01-6
    • A patient with a right frontal lobe infarction demonstrates loss of saccades to the left with preservation of pursuit.
    • Saccades; Saccadic Eye Movements; Eye Movement Disorders; Frontal Lobe Lesion;
    • Defective Saccades: Slow to No Saccades

    • Daroff_01-5
    • 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...
    • Saccades; Saccadic Eye Movements; Eye Movement Disorders;
    • Downbeat Nystagmus

    • Daroff_03-4
    • Primary position downbeat nystagmus is demonstrated, with a list of the common causes.
    • Downbeat Nystagmus
    • Eye Movement Modeling; Eye-Ear Tricks

    • Daroff_04-12
    • A surgical resident was able to combine eye and ear movements as a party trick, to intimidate a first year neurology resident.
    • Eye Movement Modeling; Eye-Ear Tricks;
    • Eyelid Nystagmus

    • Daroff_04-10
    • 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...
    • Eyelid Nystagmus
    • Gaze Evoked Ear Retraction

    • Daroff_02-10
    • 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.”
    • Gaze Evoked Ear Retraction
    • Gustatory Lid Retraction in Congenital Horner's Syndrome

    • Daroff_02-9
    • 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.
    • Horner Syndrome; Lid Retraction;
    • Horizontal Eye Movements

    • Daroff_02-2
    • 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...
    • Horizontal Eye Movements; Frontal Eye Fields; Paramedian Pontine Reticular Formation (PPRF); Medial Longitudinal Fasciculus (MLF); Oculomotor Cranial Nerves;
    • Internuclear Ophthalmoplegia

    • Daroff_02-4
    • 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...
    • Internuclear Ophthalmoplegia
    • Introduction to Eye Movements

    • Daroff_01-1
    • 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.
    • Eye Movements; Saccades; Smooth pursuit; Cerebral control of eye movements; Efferent Visual Pathways; Convergence
    • Macro Square Wave Jerks

    • Daroff_04-4
    • 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...
    • Macro Square Wave Jerks
    • Miscellaneous Ocular Oscillations

    • Daroff_Tape-4
    • 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,...
    • Ocular Motility Disorders; Eye Movement Disorders
    • Normal Vertical Eye Movements

    • Daroff_01-7
    • 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...
    • Normal Vertical Eye Movements; Vertical Saccades;
    • Nystagmus Nomenclature

    • Daroff_03-3
    • A brief discussion of the various types of nystagmus is provided.
    • Nystagmus
    • Ocular Bobbing

    • Daroff_04-9
    • 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...
    • Ocular Bobbing; Ocular Motility Disorders;
    • Ocular Dysmetria

    • Daroff_03-10
    • Upon attempted refixation, patients with this cerebellar eye sign over-shoot and oscillate, before eventually reaching their intended targets. Two patients demonstrate this disorder.
    • Cerebellar Dysmetria; Ocular Dysmetria; Other Saccadic Abnormalities
    • Ocular Flutter

    • Daroff_03-14
    • Ocular Flutter, a disorder characterized by intermittent, rapid, horizontal movements in primary position, is demonstrated in this video.
    • Ocular Flutter
    • Ocular Myasthenia Gravis

    • Daroff_02-11
    • 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...
    • Ocular Myasthenia Gravis
    • Ocular Palatal Myoclonus

    • Daroff_03-9
    • 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...
    • Ocular Palatal Myoclonus; Oculopalatal Myoclonus; Oculopalatal Tremor
    • One and Half Syndrome

    • Daroff_02-8
    • 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...
    • One and Half Syndrome; Paralytic Pontine Exotropia
    • Opsoclonus

    • Daroff_04-2
    • 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...
    • Opsoclonus; Saccadomania
    • Opsoclonus in an Infant

    • Daroff_04-1
    • 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.
    • Opsoclonus
    • Parinaud's Syndrome or Dorsal Midbrain Syndrome

    • Daroff_02-1
    • 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,...
    • Parinaud Syndrome; Dorsal Midbrain Syndrome; Eye Movement Disorders; Convergence Retraction Nystagmus
    • Pause Cell Dysfunction: Ocular Flutter

    • Daroff_03-13
    • 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.
    • Ocular Flutter
    • Pause Cell Dysfunctions

    • Daroff_04-6
    • This reviews the ocular oscillations caused by pause cell dysfunctions.
    • Pause Cell Dysfunctions
    • Periodic Alternating Nystagmus

    • Daroff_03-2
    • A patient with PAN is shown with a discussion of its appearance and etiology.
    • Periodic Alternating Nystagmus
    • Progressive Supranuclear Palsy

    • Daroff_01-9
    • 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...
    • Progressive Supranuclear Palsy; Saccades; Vertical Gaze Palsy
    • Psychogenic Gaze Palsy

    • Daroff_02-13
    • Psychogenic Gaze-Palsy is unusual but can usually be detected during Oculo-cephalics when the eyebrows don’t elevate during attempted upward gaze.
    • Psychogenic Gaze Palsy; Eye Movement Disorders
    • Pursuit System

    • Daroff_01-3
    • 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...
    • Pursuit System;
    • Recording and Modeling Eye Movements

    • Daroff_04-11
    • A brief discussion of the power and perhaps limitations of eye movement modeling is presented.
    • Eye Movement Disorders; Eye Movement Measurements;
    • Saccadic System

    • Daroff_01-2
    • 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...
    • Saccades; Eye Movements; Saccadic System
    • See-saw Nystagmus

    • Daroff_04-7
    • 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...
    • See-saw Nystagmus; Seesaw Nystagmus
    • Square Wave Jerks

    • Daroff_04-3
    • 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...
    • Square Wave Jerks
    • Superior Oblique Myokymia

    • Daroff_04-8
    • 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...
    • Superior Oblique Myokymia; Trochlear Nerve Disease;
    • Up-beat Nystagmus with Palatal Myoclonus

    • Daroff_03-8
    • A woman who appears to have upbeat nystagmus is also noted to have palatal, labial, and sternocleidomastoid myoclonus.
    • Up-beat Nystagmus; Palatal Myoclonus;
    • Upbeat Nystagmus

    • Daroff_03-6
    • 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...
    • Upbeat Nystagmus
    • Various Causes of Ophthalmoplegia

    • Daroff_02-12
    • 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...
    • Ophthalmoplegia; Decompensation of Phorias; Restriction Syndromes; Thyroid Eye Disease; Thyroid-Associated Ophthalmopathy; Blow-Out Fracture
    • Vertical Gaze Paralysis

    • Daroff_01-8
    • 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...
    • Vertical Gaze Paralysis; Eye Movement Disorders;
    • Voluntary Nystagmus

    • Daroff_04-5
    • 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...
    • Voluntary Nystagmus; Voluntary Flutter
    • Wall-Eyed Internuclear Ophthalmoplegia

    • Daroff_02-6
    • 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.
    • Wall-Eyed Internuclear Ophthalmoplegia; Internuclear Ophthalmoplegia
    • Whipples Mimicking PSP

    • Daroff_01-10
    • 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...
    • Whipple Disease; Progressive Supranuclear Palsy; Saccades; Whipple's Disease


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