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Creator: Jon Stone, MB, ChB, FRCP, PhD
Duration: 0:42
Journal: CONTINUUM: Lifelong Learning in Neurology
This video shows a positive right leg Hoover sign in the patient in Case 15-1 who developed acute right facial spasm and a right hemiparesis and was initially thought to have had a stroke.
Creator: Jon Stone, MB, ChB, FRCP, PhD
Duration: 1:46
Journal: CONTINUUM: Lifelong Learning in Neurology
This video shows a patient describing his limbs feeling alien and artificial. He has a typical dragging gait of functional hemiparesis with the hip internally rotated. With his eyes closed, the patient’s bent foot feels straight, in keeping with a distorted cerebral map.
Creator: W. David Freeman, MD, FSNS, FAAN
Duration: 2:23
Journal: CONTINUUM: Lifelong Learning in Neurology
Mild, abnormal ICP waveform during external ventricular drain (EVD) clamp trial with clustering of P1 to P3 waves. Respiratory variations are noted as well as Valsalva maneuver. The patient has muscle resistance testing of his deltoid, which causes the patient to perform the Valsalva maneuver and transiently increase ICP. Inspiration causes a decrease in ICP, and Valsalva maneuver during segmental muscle strength testing increases it.
Creator: Louise S. Roper
Duration: 1:04
Journal: CONTINUUM: Lifelong Learning in Neurology
This video shows a patient with bilateral arm tremor. When asked to do mental arithmetic, the patient exhibits little difference in tremor. When copying cued movements in one hand, the contralateral tremor initially ceases, then entrains. Ballistic movements lead to brief pauses.
Creator: Matthew J. Thurtell, MBBS, FRACP
Duration: 00:24
Journal: CONTINUUM: Lifelong Learning in Neurology August 2014, Volume 20, Issue 4, Neuro-ophthalmology;
This video shows an 18-year-old woman with oculopalatal tremor that developed several months after a pontine hemorrhage. Note that the nystagmus is very disconjugate, being predominantly horizontal in the right eye and vertical-torsional in the left eye. The patient also has synchronous palatal oscillations.
Creator: Francesca Morgante, MD, PhD
Duration: 0:40
Journal: CONTINUUM: Lifelong Learning in Neurology
First segment demonstrates a 36-year-old woman with cervical dystonia. Second segment shows a 72-year-old man with a 30-year history of task-specific focal hand dystonia. Motor overflow is evident when the patient writes. Third segment demonstrates lower limb dystonia in a patient with advanced Parkinson disease in the off-medication phase.
Creator: Kevin A. Kerber, MD, MS
Duration: 0:34
Journal: CONTINUUM: Lifelong Learning in Neurology
Spontaneous nystagmus and gaze testing in a patient who presented with acute vestibular syndrome and findings that localize to the right vestibular nerve. The patient has spontaneous left-beat nystagmus. The velocity of the nystagmus increases when he looks to the left and decreases when he looks to the right. When he looks to the right, the nystagmus does not change direction. When he looks up, the nystagmus remains left-beat. Thus, the patient has a unidirectional horizontal nystagmus.
Creator: Nancy Foldvary-Schaefer, DO, MS, FAASM
Duration: 0:49
Journal: CONTINUUM: Lifelong Learning in Neurology
Video demonstrates a bilateral, asymmetric, tonic seizure with semiology characteristic of frontal lobe (mesial) activation in a 32-year-old man with a normal MRI, no interictal discharges on scalp EEG, and a nonlocalizable scalp ictal EEG pattern. An ictal SPECT shows hyperperfusion in the left medial frontal lobe, so a stereo EEG evaluation is planned. The patient is medically intractable, with repetitive seizures at sleep-wake transition at bedtime most nights that have not responded to medication. The seizures routinely wake him up, but he typically can recall what happens during the seizure and responds immediately thereafter.
Creator: Alfonso Fasano, MD, PhD; Bastiaan R. Bloem, MD, PhD
Duration: 0:21
Journal: CONTINUUM: Lifelong Learning in Neurology
Ataxic gait in a patient with alcoholic ataxia. Note the wide base of support and feet dysmetria during stepping.
Creator: Marc Dinkin, MD
Duration: 00:14
Journal: CONTINUUM: Lifelong Learning in Neurology August 2014, Volume 20, Issue 4, Neuro-ophthalmology;
This video of the same patient as in Supplemental Digital Content 8-1 shows an exotropia (reflective of left medial rectus weakness) and a left hypotropia (reflective of left superior rectus and inferior oblique weakness). Notice how the movements of the right eye are greater than the left eye during the test, even though it is not the paretic eye; the left eye is unable to move because of paresis. The deviation of the right eye (there is both an exotropia and hypertropia) is an example of a secondary deviation and results from the Hering law of equal innervation, which states that an equal force is provided to each eye.
Creator: Alberto J. Espay, MD, MSc, FAAN
Duration: 1:13
Journal: CONTINUUM: Lifelong Learning in Neurology
An 82-year-old woman with rest and postural hand myoclonus. Once standing, she reported weakness and unsteadiness, which worsened the longer she remained erect. Electrophysiology revealed abnormal movements in her legs, which were myoclonic, and almost impossible to see, with the naked eye.
Creator: Matthew J. Thurtell, MBBS, FRACP
Duration: 00:45
Journal: CONTINUUM: Lifelong Learning in Neurology August 2014, Volume 20, Issue 4, Neuro-ophthalmology;
This video shows a 48-year-old man with upbeat and gaze-evoked nystagmus caused by Wernicke encephalopathy following gastric bypass surgery. The upbeat nystagmus is atypical in that it is less prominent with upward gaze. Note the gaze-evoked nystagmus on lateral gaze.
Creator: Alfonso Fasano, MD, PhD; Bastiaan R. Bloem, MD, PhD
Duration: 0:26
Journal: CONTINUUM: Lifelong Learning in Neurology
Hemiparetic gait in a patient with left-hemisphere stroke. Note lower limb circumduction.
Creator: Irene Litvan, MD
Duration: 1:31
Journal: CONTINUUM: Lifelong Learning in Neurology
A 52-year-old man with a clinical diagnosis of idiopathic Parkinson disease. The patient shows left-hand resting tremor with reemergence on posture and exacerbation during walking. Decrement of amplitude and speed can be seen during performance of rapid alternating movements.
Creator: Matthew J. Thurtell, MBBS, FRACP
Duration: 00:34
Journal: CONTINUUM: Lifelong Learning in Neurology August 2014, Volume 20, Issue 4, Neuro-ophthalmology;
This video shows a 44-year-old woman with multiple sclerosis and horizontal acquired pendular nystagmus. The patient also has vision loss in both eyes secondary to optic neuropathy. Note that the nystagmus is more prominent in the left eye, which is the eye with greater vision loss.
Creator: Steven Wu, MD
Duration: 0:42
Journal: CONTINUUM: Lifelong Learning in Neurology
A 10-year-old boy with multiple simple motor tics including eye rolling, eye squinting, facial grimace, raising eyebrows, neck protrusion, and shoulder shrugging. He complains of eye discomfort due to frequent tics. Toward the end of the video, he makes several simple phonic tics (expiratory “huh” sound).
Creator: Reproduced with permission from Weber KP, Aw ST, Todd MJ, et al. Head impulse tests in unilateral vestibular loss: vestibulo-ocular reflex and catch-saccades. Neurology 2008;70(6): 454Y463.
Duration: 1:24
Journal: CONTINUUM: Lifelong Learning in Neurology
Video demonstrates overt versus covert corrective saccades. In some patients, corrective saccades are easily visualized by the examiner (ie, overt saccades) whereas in other patients they may be difficult to observe or may even be imperceptible to the examiner (ie, covert saccades). This video shows examples of overt and covert corrective saccades after the head-impulse test in two patients with unilateral vestibular loss.
Creator: Irene Litvan, MD
Duration: 3:33
Journal: CONTINUUM: Lifelong Learning in Neurology
A 75-year-old woman clinically diagnosed with corticobasal syndrome. Among other features, she illustrates an asymmetric parkinsonism with a markedly dystonic right arm, myoclonus, ideomotor apraxia, and cortical sensory loss.
Creator: Mark J. Edwards, MBBS
Duration: 2:12
Journal: CONTINUUM: Lifelong Learning in Neurology
A 45-year old woman with sudden-onset right hand tremor. Tremor was present at rest, with variable posturing of right hand, and during finger movements. Tremor was disrupted and its frequency changed during finger tapping with the unaffected left hand at different rates. Tremor was temporarily suppressed when engaged in the finger-nose task with the unaffected hand.
Creator: Richard J. Barohn, MD, FAAN
Duration: 0:26
Journal: CONTINUUM: Lifelong Learning in Neurology
Video demonstrates the characteristic paradoxical increase in myotonia with repetitive hand grips, or paramyotonia, seen in patients with paramyotonia congenita. The patient is instructed to squeeze her hand closed as tightly as she can and then open her hand quickly. This maneuver is repeated to evaluate forwarm-up of myotonia or paradoxical worsening.
Creator: Soňa Nevšímalová, MD, DSc
Duration: 1:30
Journal: CONTINUUM: Lifelong Learning in Neurology
Video demonstrates an episode of sleep terror in a child that consists of sudden arousal, increase in sympathetic tone, confusion, aggressive behavior, inconsolability, and increased aggression.
Creator: Richard J. Barohn, MD, FAAN
Duration: 0:18
Journal: CONTINUUM: Lifelong Learning in Neurology
Video demonstrates the clinical evaluation of percussion myotonia over the extensor digitorum communis. A fast strike with the reflex hammer over the extensor digitorum communis produces the characteristic extension of the fingers and wrist, with subsequent myotonic catch and delay of muscle relaxation.
Creator: Massimo Pandolfo, MD; Mario Manto, MD, PhD
Duration: 0:52
Journal: CONTINUUM: Lifelong Learning in Neurology
A 25-year-old man with Friedreich ataxia since childhood, who has been in wheelchair for 3 years. Note the evident proximal weakness of the upper limbs, slowness of movement, and lack of an obvious kinetic tremor. The video also shows the characteristic eye movement abnormality of Friedreich ataxia and fixation instability with square-wave jerks. Note the absence of nystagmus.
Creator: Donald B. Sanders, MD, FAAN
Duration: 2:06
Journal: CONTINUUM: Lifelong Learning in Neurology
A 64-year-old man with acetylcholine receptor antibody positive myasthenia gravis. After withholding pyridostigmine for several days, the patient has moderate right lid ptosis and horizontal diplopia at rest. These resolved within 30 seconds after injection of 2 mg edrophonium (Tensilon) and recurred 60 seconds later.
Creator: Cindy Zadikoff, MD
Duration: 1:53
Journal: CONTINUUM: Lifelong Learning in Neurology
A 6-year-old boy displaying classic axial-predominant (neck, upper arms) myoclonus with mild associated cervical dystonia. As is typical, myoclonic movements were exacerbated during handwriting.
Creator: Jon Stone, MB, ChB, FRCP, PhD
Duration: 0:34
Journal: CONTINUUM: Lifelong Learning in Neurology
This video shows a 74-year-old woman with recurrent episodes of left functional hemiparesis. She describes acute dissociation at the onset of the symptoms and demonstrates jaw deviation to the left and left platysma contraction as part of functional facial spasm.
Creator: Christine Klein, MD
Duration: 0:33
Journal: CONTINUUM: Lifelong Learning in Neurology
Writer’s cramp in a 22-year-old woman, which developed at 6 years of age in her right hand. After switching to her left hand for writing, dystonia spread to the left arm. Over several years, the dystonia became present with other tasks and was accompanied by dystonic tremor; however, it remained bibrachial with no spread to any other body region and no further worsening.
Creator: Irene Litvan, MD
Duration: 1:45
Journal: CONTINUUM: Lifelong Learning in Neurology
A 59-year old man clinically diagnosed with progressive supranuclear palsy. The oculomotor examination shows preserved horizontal pursuit and vertical gaze pursuit. Convergence is absent, and he shows minimal square wave jerks when fixing his gaze on the camera. Optokinetic nystagmus is horizontally preserved and vertical optokinetic nystagmus is reduced, with observation of square wave jerks. He also shows poor blink rate.
Creator: Geert Mayer, MD, PhD
Duration: 0:24
Journal: CONTINUUM: Lifelong Learning in Neurology
Video demonstrates cataplexy elicited by the strong emotional stimulus of conducting an orchestra. The patient becomes excited, has loss of muscle tone with unbuckling of the knees, and falls to the ground. Consciousness is preserved completely, and he never loses awareness. He recovers quickly, regaining his muscle strength and standing up as if he never experienced the episode.
Creator: Ruth H. Walker, MB, ChB, PhD, FAAN
Duration: 0:56
Journal: CONTINUUM: Lifelong Learning in Neurology
A 45-year-old man showing mild generalized chorea, truncal rocking, and a wide-based, lurching gait. Occasional tongue protrusions, but no feeding dystonia occur.
Creator: Alfonso Fasano, MD, PhD; Bastiaan R. Bloem, MD, PhD
Duration: 0:19
Journal: CONTINUUM: Lifelong Learning in Neurology
Dyskinetic gait in a patient with lower limb dystonia because of a mitochondrial disorder. Note the left foot inversion.
Creator: David R. Williams, MBBS, PhD, FRACP
Duration: 1:47
Journal: CONTINUUM: Lifelong Learning in Neurology
A 58-year-old woman with an early clinical diagnosis of Parkinson disease who progressed to a progressive supranuclear palsy phenotype between 6 and 8 years after symptom onset (both time points shown in the video). Later development of oculomotor impairment and blepharospasm with apraxia of eyelid opening were clues regarding the revised diagnosis.
Creator: Irene Litvan, MD
Duration: 3:52
Journal: CONTINUUM: Lifelong Learning in Neurology
A 50-year-old man clinically diagnosed with multiple system atrophy, parkinsonian type. He is shown to have a tremorless parkinsonism with axial-greater-than-appendicular rigidity, distal-arm postural and stimulus-sensitive myoclonus, and slow, slightly wide-based gait with freezing and postural instability when turning.
Creator: Soňa Nevšímalová, MD, DSc
Duration: 1:14
Journal: CONTINUUM: Lifelong Learning in Neurology
Video demonstrates sleep apnea syndrome in a child. This child is overweight and has grade 4+ tonsils, which has led to complete cyclical airway occlusion and resuscitative arousals. Obstructive sleep apnea in children may have different causes and consequences than in adults. Children with untreated obstructive sleep apnea may experience neurocognitive decline, hyperactivity, hypersomnolence, and decline in IQ scores.
Creator: Kevin A. Kerber, MD, MS
Duration: 0:21
Journal: CONTINUUM: Lifelong Learning in Neurology
Patient’s head is quickly moved to one side, then to the other. On movements to the patient’s left, the eyes stay focused on the target in front of him. With head movements to the patient’s right, the eyes move off the target. He then makes a voluntary corrective saccade to bring the eyes back to the target. This is considered a positive head-impulse test to the right. The corrective saccade is more obvious after some of the tests than others, likely due to variation in the speed of the movement and the patient’s ability to predict it.
Creator: Marc Dinkin, MD
Duration: 00:40
Journal: CONTINUUM: Lifelong Learning in Neurology August 2014, Volume 20, Issue 4, Neuro-ophthalmology;
Video shows a 75-year-old man who developed gradually progressive proptosis and ptosis in his left eye accompanied by an oblique diplopia. Visual field loss and a relative afferent pupillary defect ensued in the left eye as well. Neuro-ophthalmic examination reveals that the left eye is depressed and deviates laterally in primary gaze. Testing of versions show a lack of adduction and elevation of the left eye, and limited depression which, along with ptosis, is consistent with a left oculomotor palsy. Abduction of the left eye is also limited, consistent with a left abducens palsy.
The presence of a left oculomotor palsy and an ipsilateral abducens palsy is suggestive of either cavernous sinus syndrome or orbital apex syndrome. In this case, however, the presence of an optic neuropathy (not shown), which would not occur from a cavernous sinus lesion, is the clue that the site of the lesion is the orbital apex. The proptosis is also most consistent with an orbital apex mass, and MRI with contrast (see axial and coronal images at end of video) revealed a large left orbital apex meningioma in this patient.
Creator: Francesca Morgante, MD, PhD
Duration: 0:26
Journal: CONTINUUM: Lifelong Learning in Neurology
A 56-year-old woman with hemidystonia occurring as part of multiple system atrophy. Dystonic movements affecting the right side of her body presented 1 hour after taking 150 mg of levodopa/carbidopa.
Creator: Alberto J. Espay, MD, MSc, FAAN
Duration: 0:59
Journal: CONTINUUM: Lifelong Learning in Neurology
A 32-year-old cardiorespiratory arrest survivor with action-stimulus myoclonus. This video was taken after treatment with a combination of clonazepam and levetiracetam, added sequentially to optimize outcome.
Creator: Reproduced with permission from Fife TD, Iverson DJ, Lempert T, et al. Practice parameter: therapies for benign paroxysmal positional vertigo (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology.
Duration: 0:17
Journal: CONTINUUM: Lifelong Learning in Neurology
Video demonstrates the Dix-Hallpike maneuver to the right. This maneuver should evoke paroxysmal positional nystagmus for right-sided benign paroxysmal positional vertigo related to the posterior semicircular canal. The mirror image of this maneuver constitutes a left-sided Dix-Hallpike maneuver.
Creator: Alfonso Fasano, MD, PhD; Bastiaan R. Bloem, MD, PhD
Duration: 0:14
Journal: CONTINUUM: Lifelong Learning in Neurology
Scissoring gait in a patient with secondary dystonia because of juvenile cerebral palsy.
Creator: Carlos Schenk, MD
Duration: 0:38
Journal: CONTINUUM: Lifelong Learning in Neurology
Video montage of REM sleep behavior disorder demonstrating vigorous, aggressive, and violent behaviors during REM sleep in an older adult male patient. Note violent and aggressive dream enactment correlating with dream sequence, placing both the patient and the bed partner at risk for injury.
Creator: Richard J. Barohn, MD, FAAN
Duration: 0:25
Journal: CONTINUUM: Lifelong Learning in Neurology
Video demonstrates the difficulty in opening the eyes after forced eye closure that can be seen in patients with myotonic disorders. Eye-closure myotonia is seen most frequently in patients with sodium channel mutations. The patient is instructed to squeeze his eyes shut tightly and then open them as quickly as possible. The maneuver can be repeated to check for evidence of warm-up or paradoxical worsening.
Creator: Jon Stone, MB, ChB, FRCP, PhD
Duration: 0:37
Journal: CONTINUUM: Lifelong Learning in Neurology
This video shows the patient in Case 15-1 who has right platysma contraction induced during the examination with jaw deviation to the right, which gives a superficial appearance of weakness but is actually functional facial spasm/dystonia.
Creator: Alfonso Fasano, MD, PhD; Bastiaan R. Bloem, MD, PhD
Duration: 0:15
Journal: CONTINUUM: Lifelong Learning in Neurology
Dyskinetic and stiff gait in a patient with Parkinson disease experiencing disabling levodopa-induced dyskinesia. Note the dystonic features of the left lower limb.
Creator: Reproduced with permission from Fife TD, Iverson DJ, Lempert T, et al. Practice parameter: therapies for benign paroxysmal positional vertigo (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology.
Duration: 0:46
Journal: CONTINUUM: Lifelong Learning in Neurology
Video demonstrates canalith repositioning treatment for right posterior canal benign paroxysmal positional vertigo (BPPV). The mirror image maneuver can be done for left posterior canal BPPV.
Creator: W. David Freeman, MD, FSNS, FAAN
Duration: 2:22
Journal: CONTINUUM: Lifelong Learning in Neurology
The ICP waveform shown demonstrates a value of greater than 20 mm Hg and is frankly triangular with a low compliance/high elastance appearance. CSF is drained from the external ventricular drain (EVD) system (line goes flat for a while) and is later reopened periodically. By draining CSF, this essentially changes the ICP waveform by moving down and left on the elastance curve. Later, the ICP waveform returns after the external ventricular drain is opened and some P wave components are seen. However, it is important to recognize that the ICP waveform still has an overall noncompliant morphology indicative of a persistent abnormal intracranial pressure-volume state.
Creator: Francesca Morgante, MD, PhD
Duration: 0:23
Journal: CONTINUUM: Lifelong Learning in Neurology
A 5-year-old child with generalized dystonia caused by perinatal brain injury. The first symptoms appeared in the patient’s lower limbs, affecting gait, and subsequently spreading to the trunk and upper limbs.
Creator: Soňa Nevšímalová, MD, DSc
Duration: 0:20
Journal: CONTINUUM: Lifelong Learning in Neurology
Video demonstrates benign sleep myoclonus in infancy, a disorder of quiet sleep. Its main characteristics include rhythmic myoclonic jerks when drowsy or asleep (that stop in wakefulness), and a normal encephalogram during the episodes.
Creator: Geert Mayer, MD, PhD
Duration: 0:30
Journal: CONTINUUM: Lifelong Learning in Neurology
Video demonstrates sleep terror in an adult man who experiences sudden arousal from non-REMsleep with screaming and amnesia for the event.
Creator: Alberto J. Espay, MD, MSc, FAAN
Duration: 1:03
Journal: CONTINUUM: Lifelong Learning in Neurology
A 32-year-old woman with 49 CAG repeat expansions in ataxin-2 who had onset of gait impairment in her late teens, with slowly progressive ataxia. The slowness of saccades is the diagnostic feature on examination.
Creator: David R. Williams, MBBS, PhD, FRACP
Duration: 1:37
Journal: CONTINUUM: Lifelong Learning in Neurology
Examination of a 74-year-old woman demonstrating left-sided dystonia, rigidity, apraxia, myoclonus, and cortical sensory loss. Pathologic diagnosis confirmed Creutzfeldt-Jakob disease.
Creator: Soňa Nevšímalová, MD, DSc
Duration: 0:34
Journal: CONTINUUM: Lifelong Learning in Neurology
Video demonstrates the often-stereotyped rhythmic movement of body rocking in a child. Body rocking tends to have a frequency of 1 Hz to 3 Hz and creates noise that sometimes awakens family members or bed partners.
Creator: Hrayr Attarian, MD, FAASM, FCCP
Duration: 0:38
Journal: CONTINUUM: Lifelong Learning in Neurology
Sleep terror in a 46-year-old woman with a childhood history of sleep terror who started having episodes of screaming in the middle of the night, to which she was oblivious. After a normal polysomnogram, she was admitted for video-EEG monitoring. EEG of this event (45 minutes after sleep onset) shows a mixture of large-amplitude very slow delta activity in the frontal and temporal leads and faster alphalike activity in the posterior leads. She responded to clomipramine but had adverse events and was subsequently put on 1 mg of clonazepam at bedtime, with which she experienced good control of the events.
Creator: Hrayr Attarian, MD, FAASM, FCCP
Duration: 0:50
Journal: CONTINUUM: Lifelong Learning in Neurology
Video demonstrates sleepwalking in a 34-year-old woman on zolpidem for chronic severe insomnia. The patient was seen by a community sleep doctor for episodes of sleepwalking and sleep smoking. She had let herself out of her house a few times, so safety was a concern. After a normal polysomnogram, the patient was started on clonazepam, which made her symptoms worse, and she was referred to a sleep center for a consultation. Video EEG showed normal N2 sleep during the entire 30-minute episode of sleepwalking (edited here for brevity).
Creator: Richard J. Barohn, MD, FAAN
Duration: 0:27
Journal: CONTINUUM: Lifelong Learning in Neurology
Video demonstrates the characteristic waxing and waning motor unit amplitude and frequency seen with myotonia on EMG. This produces the distinctive dive-bomber or motorcycle revving sound when amplified.
Creator: Francesca Morgante, MD, PhD
Duration: 0:31
Journal: CONTINUUM: Lifelong Learning in Neurology
A 66-year-old woman with the parkinsonian variant of multiple system atrophy. She presented with a 2-year history of gait and balance problems, parkinsonism, dysarthria, and cranial dystonia affecting the upper and lower face. Levodopa was poorly effective, induced severe orthostatic hypotension, and worsened her cranial dystonia.
Creator: Francesca Morgante, MD, PhD
Duration: 0:37
Journal: CONTINUUM: Lifelong Learning in Neurology
A 54-year-old woman with paroxysmal hyperextension of the right upper limb with wrist flexion and involuntary trunk movements. During these episodes, she exhibited lateral trunk deviation to the right side. No clear precipitating factors were evident.
Creator: Geert Mayer, MD, PhD
Duration: 0:37
Journal: CONTINUUM: Lifelong Learning in Neurology
Video demonstrates REM sleep behavior disorder in an adult man. Note the purposeful body movements correlating with dream enactment against electrographic augmentation of EMG tone.
Creator: Matthew J. Thurtell, MBBS, FRACP
Duration: 00:25
Journal: CONTINUUM: Lifelong Learning in Neurology August 2014, Volume 20, Issue 4, Neuro-ophthalmology;
This video shows a 63-year-old woman with macrosaccadic oscillations following resection of a breast cancer metastasis to the cerebellum. Note that the macrosaccadic oscillations are triggered by gaze refixations and that her horizontal saccades are hypermetric.
Creator: Soňa Nevšímalová, MD, DSc
Duration: 0:34
Journal: CONTINUUM: Lifelong Learning in Neurology
Catathrenia (ie, sleep-related groaning) consists of sleep-related respiratory noises that occur predominantly during REM sleep. The typical respiratory noise in a patient with catathrenia has an expiratory quality and responds well to therapy with continuous positive airway pressure, which suggests that catathrenia may result from upper airway restriction. Between events, the patient in this video also exhibits bruxism (ie, grinding of the teeth), which is a movement disorder of sleep and may also represent an oral parafunctional activity.
Creator: Fredy J. Revilla, MD
Duration: 2:05
Journal: CONTINUUM: Lifelong Learning in Neurology
A man who developed bilateral hand tremor at age 67, short-term memory impairment at age 70, and started falling because of poor balance at age 71. Examination revealed mild parkinsonian features and peripheral neuropathy. The patient was found to have 92 CGG repeats in the FMR1 gene, diagnostic of fragile X tremor-ataxia syndrome. Brain MRI showed hyperintensity in the middle cerebellar peduncle and the corpus callosum.
Creator: Alberto J. Espay, MD, MSc, FAAN
Duration: 0:55
Journal: CONTINUUM: Lifelong Learning in Neurology
A 32-year-old cardiorespiratory arrest survivor with action-stimulus myoclonus, magnified by the intent to move. The myoclonic jerks prevent the performance of most movements and preclude the patient’s ability to ambulate.
Creator: Alberto J. Espay, MD, MSc, FAAN
Duration: 0:25
Journal: CONTINUUM: Lifelong Learning in Neurology
A 58-year-woman with pathology-proven multiple system atrophy of 7 years’ duration demonstrating key clinical “red flags” for this disorder: axial stimulus-sensitive myoclonus, orofacial dystonia, Pisa syndrome, and wide-based gait.
Creator: Reproduced with permission from Weber KP, Aw ST, Todd MJ, et al. Head impulse tests in unilateral vestibular loss: vestibulo-ocular reflex and catch-saccades. Neurology 2008;70(6):454Y463.
Duration: 1:08
Journal: CONTINUUM: Lifelong Learning in Neurology
Video demonstrates a head-impulse test with scaled peak head velocities of 100-/s (A), 200-/s (B), and 300-/s (C) in a patient with left vestibular loss. Note the increasing salience of the catch-up saccades with stimulus size. The picture-in picture shows the online feedback trace (500 milliseconds) of angular head velocity (-/s) for the examiner. Head velocity was measured with a search coil mounted on a dental impression plate.
Creator: David R. Williams, MBBS, PhD, FRACP
Duration: 1:07
Journal: CONTINUUM: Lifelong Learning in Neurology
A 75-year-old woman with a pathologic diagnosis of vascular parkinsonism demonstrating severe gait impairment with start hesitation, short- and wide-stepped gait, and reliance on a walker for ambulation.
Creator: Donald B. Sanders, MD, FAAN
Duration: 1:26
Journal: CONTINUUM: Lifelong Learning in Neurology
An 84-year-old man who has had myasthenia gravis for 3 years. The disease began with neck weakness, followed by asymmetric, bilateral lid ptosis. Examination demonstrates mild, fatigable diplopia on lateral gaze to either side, unmasked by cover/uncover maneuver.
Creator: Alberto J. Espay, MD, MSc, FAAN
Duration: 1:43
Journal: CONTINUUM: Lifelong Learning in Neurology
A 23-year-old woman with lupus who has experienced finger shakes since the age of 16. These difficult-to-characterize, tremulous movements (of lower amplitude than, and not as fast as, myoclonus), were ultimately categorized as neuromyotonia or electric myokymia, a peripheral nerve hyperexcitability disorder.
Creator: Rama Maganti, MD
Duration: 0:56
Journal: CONTINUUM: Lifelong Learning in Neurology
Video demonstrates sleep terror in an adult woman. She screams suddenly, beginning from slow-wave non-REM sleep. The video segment after the event illustrates conversation with the technologist in which the patient recalls being awakened, but has little recollection for the event, and returns to baseline fairly quickly.
Creator: Francesca Morgante, MD, PhD
Duration: 0:23
Journal: CONTINUUM: Lifelong Learning in Neurology
A 78-year-old woman with a 25-year history of craniocervical dystonia. Blepharospasm occurred when the patient was 53 years old, and dystonia spread to her oromandibular (at 55 years old) and cervical areas (at 60 years old).
Creator: Reproduced with permission from Fife TD, Iverson DJ, Lempert T, et al. Practice parameter: therapies for benign paroxysmal positional vertigo (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology.
Duration: 0:25
Journal: CONTINUUM: Lifelong Learning in Neurology
Video demonstrates the Semont liberatory maneuver for right posterior canal benign paroxysmal positional vertigo (BPPV). The mirror image maneuver can be done for left posterior canal BPPV.
Creator: Alberto J. Espay, MD, MSc, FAAN
Duration: 0:59
Journal: CONTINUUM: Lifelong Learning in Neurology
A 62-year-old woman with sudden-onset left foot posturing after a minor motor vehicle accident 7 years ago. Fixed foot flexion and inversion are present, with excessive pain and associated abnormalities of skin coloration and sweating. She was diagnosed with complex regional pain syndrome type 1.
Creator: Richard J. Barohn, MD, FAAN
Duration: 0:46
Journal: CONTINUUM: Lifelong Learning in Neurology
Video demonstrates the characteristic reduction in myotonia, or warm-up, with repetitive hand grips seen in patients with myotonia congenita. The patient is instructed to squeeze his hand closed as tightly as he can and then open his hand quickly. This maneuver is repeated to evaluate for warm-up of myotonia or paradoxical worsening.
Creator: Wendy M. King, PT
Duration: 0:31
Journal: CONTINUUM: Lifelong Learning in Neurology
A 45-year-old woman with facioscapulohumeral dystrophy with slowly progressive weakness and increased difficulty with ambulation and falls over a 15-year period. She was prescribed a set of stance control knee-ankle-foot orthoses with hinged knee joints that locked during stance phase and released with plantar flexion during the push-off phase of her gait. Using these braces, she resumed walking, and her falls ceased.
Creator: Andrew P. Duker, MD
Duration: 1:32
Journal: CONTINUUM: Lifelong Learning in Neurology
A 33-year-old man with childhood-onset motor and vocal tics that improved and nearly resolved in his twenties but returned in his thirties. As demonstrated, complex motor tics involve cervical, pharyngeal, and laryngeal muscle groups. The urge to perform tic movements was suppressible during requested performance of complex motor tasks. Although suppressibility is a functional or psychogenic feature, this patient has Tourette syndrome, with recrudescence of tics into adulthood.
Creator: Soňa Nevšímalová, MD, DSc
Duration: 0:24
Journal: CONTINUUM: Lifelong Learning in Neurology
Video demonstrates rhythmic stereotyped body rocking in a child. Rhythmic movement disorders usually begin in the first year of life and spontaneously remit by 4 years of age.
Creator: Rama Maganti, MD
Duration: 0:24
Journal: CONTINUUM: Lifelong Learning in Neurology
Video demonstrates head banging in a child. Head banging consists of stereotyped and repetitive rhythmic movements of the head that occur during wake-to-sleep transitions and wakefulness.
Creator: Geert Mayer, MD, PhD
Duration: 0:24
Journal: CONTINUUM: Lifelong Learning in Neurology
Video demonstrates body rocking in an adult leading to 1-Hz to 2-Hz movement artifact in the polysomnogram. Body rocking is a sleep-related rhythmic movement disorder that interferes with normal sleep and can result in self-inflicted bodily injury.
Creator: Francesca Morgante, MD, PhD
Duration: 0:59
Journal: CONTINUUM: Lifelong Learning in Neurology
A 51-year-old man exhibiting gait impairment, right hand action tremor, and left leg resting tremor. Examination showed brief motor arrests during gait initiation and turning, steppage of the left foot, and fixed posture of both hands. While sitting, fixed hand posturing disappeared during distraction maneuvers. Leg tremor was present when the foot was resting on the anterior sole but not when resting on the heel or when unsupported. Deliberate slowness in both upper limbs was demonstrated during finger-to-nose movements and repetitive arm movements, although spontaneous movements were normal, as was writing.
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