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Video 6-1. The past pointing test. With eyes closed, the patient is instructed to lift his arm off the target and then bring the finger back down in the same spot. The patient in the video consistently misses the target to the right side, which is the affected side. Note that the patient in this video is the same patient in Video 6-5.

Video 6-2. The head thrust test. The patient’s eye stay fixed on the target after quick, small amplitude movements of the patient’s head to the left, which is consistent with an intact vestibular ocular reflex on the left side (i.e., negative head thrust test). However, after head movements to the patient’s right side, the patient’s eyes move off the target and then a re-fixation (corrective) saccade is required to bring the eyes back to the target, which is consistent with a positive head thrust test on the right side indicating de-afferentation or a lesion of the right vestibular system. Note that the patient in this video is the same patient in Video 6-5.

Video 6-3. The head thrust test. Note that after quick small amplitude movements of the patient’s head to the right side, the patient needs to make a corrective saccade to bring the eyes back to the target (i.e., a positive head thrust test). But, the eyes stay on target after the head thrust test to left side (i.e., a negative head thrust test). This video is particularly helpful for demonstration purposes because the voluntary corrective saccade to the right side is delayed on the first test.

Video 6-4. Spontaneous nystagmus. Patient with high velocity spontaneous left beating nystagmus which increases velocity when the patient looks to the left side and then stops when the patient looks to the right side. This recording was made on the first day of a vestibular neuritis presentation.

Video 6-5. Spontaneous nystagmus. The patient has spontaneous left-beating nystagmus. The patient was videotaped on the second day of a vestibular neuritis, and thus the velocity of the nystagmus is less than seen in Video 6-4.  

Video 6-6. Second degree nystagmus. The nystagmus velocity increased when the patient looks to the left. The nystagmus stops when the patient looks to the on right gaze. Note that the patient in this video is the same patient in Video 6-5.

Video 6-7. Spontaneous down-beating nystagmus. In primary position, the patient has persistent small amplitude down-beating nystagmus.

Video 6-8. Spontaneous up-beating nystagmus. In primary position, the patient has persistent small amplitude up-beating nystagmus.

Video 6-9. Gaze-evoked nystagmus (multi-directional) in a patient presenting with acute vertigo and imbalance. Note the prominent left-beating nystagmus in left gaze. Next, note that the patient clearly also develops right and down-beating nystagmus on right gaze. Because the nystagmus changes direction, this is a central pattern even though the velocity is greater in one direction.

Video 6-10. Gaze-evoked nystagmus and impaired smooth pursuit. The patient develops right beating nystagmus when the patient looks to the right side and left-beating nystagmus when looking to the left side. Also note the impairment of smooth pursuit (i.e., saccadic pursuit) as the patient follows a target back and forth.

Video 6-11. Gaze-evoked downbeating nystagmus. On gaze to either side, the patient develops down-beating nystagmus.

Video 6-12. Benign positional vertigo, posterior canal. The patient was just placed in the right head-hanging position (i.e., right Dix-Hallpike position). After a brief delay, a burst of upbeat and torsional nystagmus is seen. The duration of the nystagmus is about 12 seconds.

Video 6-13. Benign positional vertigo, posterior canal, testing using goggles. Video goggles were used in this video. The patient is place in the left Dix-Hallpike position and a burst of upbeat torsional nystagmus is seen.

Video 6-14. Convergence retraction nystagmus. The patient has spontaneous convergence nystagmus. Also note that the patient has impaired upgaze.

Video 6-15. Ocular flutter: Spontaneous bursts of back and forth horizontal saccades consistent with ocular flutter. Note that there is no pause between the individual saccades.

Video 7-1. Saccade dysmetria. The patient is being instructed to look back and forth from one target to another. With each saccade eye movement, the patient overshoots the target then has to make another saccade back to the target.

Video 10-1. Epley Maneuver for right posterior canal benign positional vertigo. First, the patient’s head is turned to the right side. Next, the patient is rapidly brought down to the right head hanging position (i.e., the right Dix-Hallpike test). The clinician observes for the typical burst of upbeat and torsional nystagmus (see Video 6-7). Next the patient’s head is turn toward the left and the patient rolls over onto the left side, making certain not to allow the patient to lift the head up. At the end of this position, the patient is lying on the left side with the face turned so the patient is looking at the ground. This position is maintained for about 30 seconds. Then, the patient is rapidly brought back up to the sitting position.

Video 10-2. The Gufoni maneuver for patients with left horizontal canal benign positional vertigo. From the seated position, the patient is quickly placed in the right decubitus position. This position is maintained for approximately 10-20 seconds. Next, the patient’s head is turned so that the patient is looking into the table. This position is maintained for approximately 20-30 seconds, then the patient is quickly brought back up to sitting position.

 

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