Anton Syndrome Legend: Video shows a 48-year-old man with complete loss of vision following bilateral occipital cardioembolic strokes. He denied blindness and said he felt “super.” He confabulated that he could see objects in front of him but when asked to describe them in detail, said “I don’t know how to tell.” He had no difficulty identifying objects when he held them in his hand. Even following demonstrations that he was not seeing properly, he insisted “my vision is OK.” Duration: 2:52 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(5):1329-1361, October 2019 October 2020, Volume 26, Issue 5; Published on: 10.09.2019
Apperceptive Visual Agnosia Legend: Video shows a 23-year-old woman who developed severe visual impairments after hypoxic arrest from a narcotic overdose. She described her vision as distorted or blurred. She could tell an object was in front of her but could not tell what it was. Faces were “completely distorted.” She could not identify any visually presented objects, read letters, or copy simple line drawings correctly. Visual acuity, tested with the preferential looking test (patient directs the eyes toward a set of black-and white stripes, in which the thickness of the stripes in some examples approximates 20/20 vision) was normal; she had no other cognitive deficits. Duration: 1:59 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(5):1329-1361, October 2019 Published on: 10.09.2019
Central Hemiachromatopsia Legend: Video shows a 57-year-old woman who presented with a left superior quadrant homonymous field deficit due to a right inferior occipital stroke. Examination showed that she was unable to discriminate colors in the left inferior homonymous field, saying that cards of various colors shown in that area were gray or white. Diffusion-weighted MRI showed acute right inferior occipital infarction, involving the inferior bank of area V1 and area V4. Duration: 1:50 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(5):1329-1361, October 2019 Published on: 10.09.2019
Alexia Without Agraphia Legend: Video shows a 41-year-old man with an infiltrating glioma involving the left occipital lobe and splenium of the corpus callosum with a profound inability to read words with both regular or irregular phonemic spelling, although writing and spoken language remained normal. He was unable to read a sentence he had written himself, saying “I don’t know; it’s almost like I didn’t write it.” The examination also demonstrated a right superior greater than inferior homonymous hemianopia. Duration: 2:18 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(5):1329-1361, October 2019 Published on: 10.09.2019
Prosopagnosia Legend: Video shows a 37-year-old woman with difficulty distinguishing faces due to breast cancer metastasis involving the right occipitotemporal cortex in the fusiform face area. She said that faces look “smoother and less defined.” She called it the “Instagram filter” in her brain. Duration: 2:22 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(5):1329-1361, October 2019 Published on: 10.09.2019
Riddoch Syndrome Legend: Video shows a 15-year-old girl who developed a dense right homonymous visual field deficit after left posterior cerebral artery stroke following a traumatic head injury with expansion of an epidural hematoma. As she recovered, she found that she could detect motion in the otherwise blind field. Static Humphrey automated perimetry testing demonstrated the right homonymous field defect. Duration: 1:28 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(5):1329-1361, October 2019 Published on: 10.09.2019
Balint Syndrome Legend: Video shows a 70-year-old woman who reported difficulty reaching for things. She could read but had difficulty moving from one word to the next and felt confused when she entered a place with complex visual stimuli. When asked what letter she saw in a picture of an H made of little As, she answered “A,” even when directed to look at the whole picture. Examination revealed ocular apraxia, optic ataxia, and simultagnosia, leading to a diagnosis of Balint syndrome. Duration: 0:48 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(5):1329-1361, October 2019 Published on: 10.09.2019
Charles Bonnet Syndrome Legend: Video shows a 93-year-old woman with severe visual loss from macular degeneration and glaucoma had frequent complex visual hallucinations. She described seeing “a little blond dressed very nice…in a wool plaid suit, skirt, and jacket, and curly, curly hair and big, round eyes.” The hallucinations were nonthreatening, and she had no auditory hallucinations. Duration: 1:42 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(5):1329-1361, October 2019 Published on: 10.09.2019
Lhermitte Peduncular Hallucinosis Legend: Video shows a 66-year-old man with the sudden onset of vivid visual hallucinations during wakefulness following bariatric surgery. Apart from describing the hallucinations, he was alert, attentive, and fully oriented without any confusion. He described seeing in his hospital room, for example, synchronized swimmers, snakes crawling up to the bed, numbers melting off the clock, and plumes of smoke at the nursing station. Diffusion-weighted imaging (DWI) and apparent diffusion coefficient MRI demonstrated a mesencephalic stroke, consistent with a diagnosis of peduncular hallucinosis. Duration: 1:36 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(5):1329-1361, October 2019 Published on: 10.09.2019
Examination of Fixation Legend: The patient is asked to maintain focus on a visual target (the “big 9” at the top of a Rosenbaum Vision Screen is preferred). The examiner should note the patient’s ability to maintain stability of gaze, paying particular attention to square-wave jerks, other saccadic intrusions, or nystagmus. Duration: 0:33 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(5):1362-1375, October 2019 Published on: 10.09.2019
Examination of Ductions Legend: One of the patient’s eyes is covered, and with the other eye, he is asked to follow a visual target slowly through the cardinal positions of gaze. Duration: 2:16 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(5):1362-1375, October 2019 Published on: 10.09.2019
Examination of Versions Legend: The patient is asked to follow a target through the cardinal positions of gaze while viewing it with both eyes. The examiner should note whether ocular pursuit movements are smooth and controlled; this also allows for any asymmetry between the degree of movement of each globe compared to the other to be noted. Duration: 0:58 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(5):1362-1375, October 2019 Published on: 10.09.2019
Examination of Saccades Legend: The patient is asked to maintain fixation on a central target, then to rapidly direct his gaze to an eccentric target, then back to central fixation. This should be performed in both the horizontal and vertical planes. Duration: 0:56 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(5):1362-1375, October 2019 Published on: 10.09.2019
Jerk Nystagmus Legend: Video shows unidirectional left-beat jerk nystagmus in a patient with multiple sclerosis with a demyelinating lesion of the right vestibular nuclei. The pathologic component of the nystagmus is repetitive slow drifting of the eyes toward the right followed by corrective resetting fast phases toward the left, after which the nystagmus is named. Duration: 0:33 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(5):1376-1400, October 2019 Published on: 10.09.2019
Acquired Pendular Nystagmus Legend: Video shows acquired pendular nystagmus in a patient with multiple sclerosis with chronic optic nerve demyelination and diffuse cortical and posterior fossa demyelinating lesions. In the upper black-and-white eye movement videos, note the predominantly horizontal sinusoidal back-to-back slow oscillations without any fast phases. The bottom portions of the video show the eye position (red line is horizontal eye position, blue line is vertical eye position) and velocity (purple and green lines) traces of the nystagmus. The sinusoidal oscillation in the red line corresponds to the horizontal oscillations of the eyes. A slight vertical oscillation is also seen. Duration: 0:49 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(5):1376-1400, October 2019 Published on: 10.09.2019
Square-Wave Jerks Legend: The first video segment shows nearly continuous square-wave jerks in a patient with progressive supranuclear palsy. The second video segment shows impaired upgaze range with slow upward saccades. Duration: 0:38 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(5):1376-1400, October 2019 Published on: 10.09.2019
Square-Wave Oscillations Legend: Video shows high-resolution infrared video recordings of a patient with back-to-back runs of square-wave jerks, termed square-wave oscillations. Duration: 1:01 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(5):1376-1400, October 2019 Published on: 10.09.2019
Macrosaccadic Oscillations Legend: Video shows macrosaccadic oscillations in a patient who had a pontine infarction and subsequently reported oscillopsia. Duration: 00:41 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(5):1376-1400, October 2019 Published on: 10.09.2019
Ocular Flutter and Opsoclonus Legend: The first video segment shows ocular flutter, and the second video segment shows opsoclonus in a patient with a parainfectious brainstem encephalitis, with subacute onset oscillopsia, ataxia, and truncal myoclonus. No specific infectious organism was identified. Neoplastic and paraneoplastic evaluation was unremarkable. Recovery occurred over 3 months. In the video, flutter transitions to opsoclonus at 33 seconds. Duration: 1:50 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(5):1376-1400, October 2019 Published on: 10.09.2019
Acquired Pendular Nystagmus in Multiple Sclerosis Legend: Video shows acquired pendular nystagmus in a patient with multiple sclerosis. The first video segment shows minimal to no movement in the right eye and small horizontal pendular oscillations in the left eye. The second segment shows a magnified view of the right eye, with minimal to no visible movement in the right eye. The third segment shows a magnified view of the left eye, with small horizontal pendular oscillations. The fourth video segment shows marked saccadic hypermetria, evidence that this patient also had cerebellar dysfunction, as is typical of most patients with acquired pendular nystagmus from multiple sclerosis. Duration: 1:16 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(5):1376-1400, October 2019 Published on: 10.09.2019
Acquired Pendular Nystagmus in Oculopalatal Myoclonus Legend: The first video segment shows oculopalatal myoclonus with large vertical pendular nystagmus, and the second video segment shows palatal myoclonus in a patient who developed severe oscillopsia several months after a brainstem stroke. In the first segment, note the lack of horizontal eye movement from the original pontine infarction. Vertical range of eye motion is full. Duration: 2:12 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(5):1376-1400, October 2019 Published on: 10.07.2019
Acquired Pendular Nystagmus in Oculopalatal Myoclonus Legend: Video shows a patient with oculopalatal tremor with asymmetric pendular nystagmus. The movement is vertical-torsional in the right eye and predominantly torsional in the left eye with smaller-amplitude movement. Duration: 00:40 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(5):1376-1400, October 2019 Published on: 10.07.2019
Posterior Canal Benign Paroxysmal Positional Legend: Video demonstrates the nystagmus seen in a positive Dix-Hallpike maneuver in a patient with right posterior canal benign paroxysmal positional vertigo. When the patient is rapidly positioned supine with the right ear down, torsional upbeat nystagmus begins after a short delay, with the torsional component manifested as the top poles of the eyes beating toward the right ear. Note the fatigable intensity of the nystagmus over time. Frenzel goggles eliminate the patient’s ability to fixate and enhance the view of the examiner, although this type of nystagmus will typically be visible without Frenzel goggles. Duration: 00:37 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(5):1376-1400, October 2019 Published on: 10.07.2019
Periodic Alternating Nystagmus Legend: The first video segment shows the left-beat component of periodic alternating nystagmus in a patient with multiple sclerosis who had oscillopsia; the second video segment shows the right-beat component. Transitioning between right-beat and left-beat nystagmus occurred every 90 seconds. Treatment with baclofen stopped the nystagmus completely. Duration: 00:41 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(5):1376-1400, October 2019 Published on: 10.07.2019
Upbeat Nystagmus Legend: Video shows a patient with Wernicke encephalopathy with upbeat nystagmus in the central position that, in keeping with the Alexander law, increases in upgaze. Bilateral horizontal ocular motor range limitations are also present, with incomplete right eye abduction and incomplete left eye abduction and adduction. Duration: 00:52 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(5):1376-1400, October 2019 Published on: 10.07.2019
Downbeat Nystagmus Legend: A patient with a Chiari I malformation exhibits downbeat nystagmus in downgaze. Magnified view of the right eye exhibits a trace amount of downbeat nystagmus in right downward gaze. The downbeat nystagmus is more obvious in left downward gaze. High-resolution infrared video shows downbeat nystagmus in down and lateral gaze. At the end of the video, the downbeat nystagmus is visualized in the central position. Duration: 00:53 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(5):1376-1400, October 2019 Published on: 10.07.2019
Gaze-Evoked Nystagmus Legend: Video shows pathologic gaze-evoked nystagmus in a patient with a Chiari I malformation. The first segment shows right-beat nystagmus in right gaze, the second segment shows left-beat nystagmus in left gaze followed by rebound right-beat nystagmus upon return to central position and rebound nystagmus, and the third segment shows downbeat nystagmus. Duration: 0:55 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(5):1376-1400, October 2019 Published on: 10.07.2019
Congenital Nystagmus Legend: Video shows congenital nystagmus (infantile nystagmus syndrome) in a patient with lifelong nystagmus, albinism, and no oscillopsia. Note the horizontal, predominantly pendular trajectory of the nystagmus that is consistent in all gaze positions, even vertical gaze. Duration: 1:00 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(5):1376-1400, October 2019 Published on: 10.07.2019
Ocular Flutter Legend: Video shows a patient with runs of back-to-back horizontal saccades, consistent with ocular flutter. Note that in this patient, they were elicited by voluntary lateral saccades. Ocular flutter typically occurs in the setting of cerebellar disease, either from an infectious or parainfectious cerebellitis or paraneoplastic disease. Duration: 00:31 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(5):1401-1421, October 2019 Published on: 10.07.2019
Opsoclonus Legend: Video shows a patient with runs of back-to-back saccades in all directions, consistent with opsoclonus. Opsoclonus consists of high-frequency saccadic movements that may be of large amplitude and lack an intersaccadic interval. It localizes to brainstem or cerebellar damage, often resulting from paraneoplastic disease, with or without myoclonus, typically from neuroblastoma in children and small cell lung carcinoma or ovarian cancer in adults. Duration: 00:26 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(5):1401-1421, October 2019 Published on: 10.07.2019
Parkinson disease Legend: Video shows a 67-year-old man with Parkinson disease exhibiting resting tremor of his right arm and decreased arm swing during gait testing. Duration: 0:42 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(4):896-918, August 2019 Published on: 08.07.2019
Dyskinesia Legend: Video shows a 67-year-old man with advanced Parkinson disease exhibiting involuntary choreiform movements in his limbs, neck, and torso, consistent with levodopa-induced dyskinesia. Duration: 0:37 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(4):896-918, August 2019 Published on: 08.07.2019
Dystonia Legend: Video shows a 64-year-old man with advanced Parkinson disease, off carbidopa/levodopa, exhibiting involuntary dorsiflexion of his feet, consistent with “off” dystonia. Duration: 0:28 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(4):896-918, August 2019 Published on: 08.07.2019
Multiple system atrophy Legend: Video shows a man with signs of a mild cerebellar syndrome. Duration: 1:26 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(4):919-935, August 2019 Published on: 08.07.2019
Tourette syndrome Legend: Video shows a boy with Tourette syndrome demonstrating frequent blinking, alternating facial contractions, tongue protrusions, and mouth openings. Duration: 0:42 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(4):936-958, August 2019 Published on: 08.07.2019
Dystonic tics Legend: Video shows a girl exhibiting facial tics manifested by repetitive sustained contractions of facial muscles, resulting in grimacing and neck muscle contractions typical of dystonic tics. Duration: 0:42 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(4):936-958, August 2019 Published on: 08.07.2019
Repetitive complex movements Legend: Video shows a boy with Tourette syndrome displaying repetitive, complex movements produced by contractions of his shoulder and trunk muscles, preceded by an intense premonitory sensation of a chill. Duration: 1:05 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(4):936-958, August 2019 Published on: 08.07.2019
Dystonic, vocal, and holding (blocking) tics Legend: Video shows a boy with Tourette syndrome exhibiting a dystonic extension of his neck associated with repetitive expiratory grunting sounds. In addition, he demonstrates a holding (blocking) tic, during which time he stops breathing and is completely motionless. Duration: 1:09 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(4):936-958, August 2019 Published on: 08.07.2019
Complex motor and phonic tics Legend: Video shows a 17-year-old girl with severe Tourette syndrome exhibiting complex motor tics and loud screaming phonic tics. Duration: 1:00 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(4):936-958, August 2019 Published on: 08.07.2019
Complex motor and phonic tics Legend: Video shows a boy with severe Tourette syndrome exhibiting complex motor and loud phonic tics, including coprolalia. Duration: 1:23 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(4):936-958, August 2019 Published on: 08.07.2019
Essential Tremor Legend: Video shows a man with essential tremor exhibiting a severe kinetic tremor while pouring water between two cups. The tremor is slightly asymmetric and is worse on the right. Duration: 1:01 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(4):959-975, August 2019 Published on: 08.07.2019
Drug-induced action tremor Legend: Video shows a man with drug-induced action tremor due to lithium exhibiting both a postural and a kinetic tremor of mild to moderate amplitude. Duration: 0:50 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(4):959-975, August 2019 Published on: 08.07.2019
Dystonic tremor Legend: Video show a man with dystonic tremor exhibiting a tremor in the neck that is neither rhythmic nor oscillatory. Duration: 0:28 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(4):959-975, August 2019 Published on: 08.07.2019
Holmes tremor Legend: Video show a woman with Holmes tremor exhibiting a unilateral, slow tremor at rest, which worsens during sustained posture. Duration: 0:51 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(4):959-975, August 2019 Published on: 08.07.2019
Parkinson disease tremor Legend: Video shows a woman with Parkinson disease exhibiting a resting tremor, primarily on the left, while seated. A reemergent tremor is apparent, emerging after several seconds and then worsening, as she holds her arms in front of her body. Duration: 0:38 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(4):959-975, August 2019 Published on: 08.07.2019
Hemiballism secondary to central nervous system toxoplasmosis Legend: Video shows a 54-year-old man with left hemiballism exhibiting large-amplitude movements involving the predominantly proximal arm and leg. On MRI, fluid-attenuated inversion recovery (FLAIR) images show numerous multifocal hyperintense lesions that also involve the basal ganglia. Duration: 0:47 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(4):1001-1035, August 2019 Published on: 08.02.2019
Hemichorea secondary to nonketotic hyperglycemia Legend: Video shows a 77-year-old woman with hemichorea secondary to nonketotic hyperglycemia and demonstrates left hemichorea involving the face, arm, and leg as well as hemichoreic gait. Duration: 0:51 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(4):1001-1035, August 2019 Published on: 08.02.2019
Lupus chorea Legend: Video shows a 29-year-old woman with acute generalized chorea and encephalopathy as her first presentation of systemic lupus erythematosus. Both chorea and her mental status improved after 3 days of treatment with IV steroids and tetrabenazine 75 mg/d. Duration: 0:43 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(4):1001-1035, August 2019 Published on: 08.02.2019
Sydenham chorea Legend: Video shows an 8-year-old boy with Sydenham chorea who presented with an acute temporal profile of severe generalized chorea. He also displays hypotonia and milkmaid’s grip. He is unable to stand unassisted. Duration: 0:46 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(4):1001-1035, August 2019 Published on: 08.02.2019
Huntington disease Legend: Video shows the 83-year-old woman with Huntington disease and exhibits generalized chorea including upper and lower facial involvement, parakinesia, motor impersistence involving the tongue, milkmaid’s grip, and choreic gait. Hung-up knee jerk is also shown. Duration: 1:11 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(4):1001-1035, August 2019 Published on: 08.02.2019
Huntington disease–like 2 Legend: Video shows an 56-year-old woman exhibiting generalized chorea and tongue impersistence. She is originally from Barbados with African ancestry. Genetic testing for Huntington disease is negative, and she is genetically confirmed to have mutations in JPH3 diagnostic of Huntington Disease–like 2. Duration: 0:52 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(4):1001-1035, August 2019 Published on: 08.02.2019
Chorea-acanthocytosis Legend: Video shows a 36-year-old woman with chorea-acanthocytosis. The first video segment demonstrates severe tongue protrusion or feeding dystonia. In the second segment, she exhibits a mild parkinsonian appearance and lower facial and left arm dystonia, but only mild truncal chorea. She walks with stutter steps and has circumduction of the left leg. Duration: 0:53 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(4):1001-1035, August 2019 Published on: 08.02.2019
Different degrees of gait ataxia Legend: The first video segment shows an 18-year-old man with ataxia with oculomotor apraxia type 2. Mild gait ataxia can manifest with variable step length, side steps, and veering toward one side without a marked wide base. The second video segment shows a 37-year-old man with idiopathic cerebellar ataxia. In patients with moderate ataxia, the gait becomes wide based with obvious variable stride lengths. The third video segment shows a 32-year-old woman with spinocerebellar ataxia type 2. In the advanced stages of ataxia, a wide-based gait is more evident, and the stride length becomes shorter to compensate for ataxia. Duration: 1:16 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(4):1036-1054, August 2019 Published on: 08.02.2019
Multiple system atrophy, cerebellar type Legend: Video shows the 56-year-old woman who developed imbalance and walked “as if she were drunk.” She veered toward one side while walking, had two episodes of syncope, and her speech and hand dexterity were subsequently involved. On examination, she has hypomimic facial expression, hypermetric saccades, dysmetria on finger-nose-finger tests, bradykinesia in finger taps, and ataxic gait with variable footsteps. Her postmortem brain pathology demonstrated glial cytoplasmic inclusions along with olivopontocerebellar atrophy, confirming the diagnosis of multiple system atrophy, cerebellar type. Duration: 1:00 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(4):1036-1054, August 2019 Published on: 08.02.2019
Spinocerebellar ataxia type 2 Legend: The first video segment shows the 55-year-old woman with spinocerebellar ataxia type 2. She has limited upward gaze and slow saccadic eye movements without nystagmus or hypermetric or hypometric saccades. She has dysmetria on finger-nose-finger tests and an overshoot in finger chase tests. She also has impaired rapid alternating movements. Her facial expression is hypomimic, and her gait is wide based and shows variable stride length. The second video segment shows the same patient 5 years later. Her symptoms have progressed. She has ophthalmoparesis, particularly in vertical gaze, and her saccadic eye movements have become very slow. Duration: 2:04 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(4):1036-1054, August 2019 Published on: 08.02.2019
Niemann-Pick disease type C Legend: Video shows a 30-year-old man with Niemann-Pick disease type C. He has relatively preserved smooth pursuit in the horizontal direction without end-gaze nystagmus. He can perform upward pursuit, but his downward pursuit movements are extremely slow. He also has relatively preserved horizontal saccades and has great difficulty in vertical saccades, particularly in the downward direction. Duration: 0:51 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(4):1036-1054, August 2019 Published on: 08.02.2019
Tardive dyskinesia and stereotypy Legend: Video shows the 78-year-old man exhibiting involuntary mouth movements indicative of tardive dyskinesia and stereotypy. Exposure to a second-generation antipsychotic drug at usual doses may result in tardive syndromes in a patient with no risk factors other than age. Duration: 0:51 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(4):1081-1098, August 2019 Published on: 08.02.2019
Tardive dyskinesia and tardive dystonia Legend: Video shows the 64-year-old woman discussed in Case 9-2 exhibiting continuous chewing movements, lip puckering, blepharospasm, and left leg stereotypies indicative of tardive dyskinesia and tardive dystonia. Her posture reveals moderate torticollis, with her head rotated to her right and the right shoulder mildly elevated. The patient’s movement disorder is generalized, involving face, neck, and trunk. Duration: 1:13 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(4):1081-1098, August 2019 Published on: 08.02.2019
Leg stereotypies or dystonia Legend: Video shows the legs of a 95-year-old woman exhibiting bilateral leg movements that may be classified as stereotypies or dystonia. The patient also exhibits tachypneic breathing, which is a symptom of the tardive syndrome. Duration: 0:51 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(4):1081-1098, August 2019 Published on: 08.02.2019
Tardive akathisia Legend: Video shows the 45-year-old with tardive akathisia exhibiting severe restlessness. The patient also has oral, buccal, and lingual dyskinesias (not shown). Duration: 0:38 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(4):1081-1098, August 2019 Published on: 08.02.2019
Classic tardive dyskinesia. Legend: Video shows a 78-year-old woman with symptoms of classic tardive dyskinesia, involving oral, buccal, and lingual movements. She is the same patient, 33 years later. She has continuous writhing movements of her tongue as well as continuous lip and jaw movements. Duration: 1:04 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(4):1081-1098, August 2019 Published on: 08.02.2019
Mild, segmental tardive dystonia with associated tachypnea Legend: Video shows a 70-year-old man with mild, segmental tardive dystonia exhibiting irregular contractions of the corners of his mouth, asymptomatic tachypnea, and a masked facial expression. The mouth movements are dystonic in nature, and he has no other signs of a tardive syndrome. He had been treated with chlorpromazine, risperidone, and other antipsychotics for several decades. His movements developed when risperidone was changed to quetiapine. At the time of this video, the patient was taking risperidone 0.5 mg twice daily and tetrabenazine 12.5 mg twice daily. Duration: 0:50 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(4):1081-1098, August 2019 Published on: 08.02.2019
Tardive tics Legend: Video shows the 61-year-old woman exhibiting tardive tics primarily involving her legs, right more than left. Tardive tics are uncommon, and these are particularly unusual in that the patient is unaware of them and is not bothered by them. Duration: 1:56 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(4):1081-1098, August 2019 Published on: 08.02.2019
Psychogenic tremor Legend: Video shows a 51-year-old man with psychogenic tremor exhibiting involuntary movements of the head, neck, shoulders, arms, and trunk, which are intermittent, distractible, variable, and entrainable. Duration: 0:51 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(4):1121-1140, August 2019 Published on: 08.02.2019
Psychogenic chorea and gait disorder Legend: Video shows a 47-year-old woman with psychogenic chorea and gait disorder exhibiting jerky intermittent tremors and choreiform movements in both of her hands, which are distractible, variable, suggestible, and entrainable. Duration: 1:39 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(4):1121-1140, August 2019 Published on: 08.02.2019
Psychogenic palatal myoclonus Legend: Video shows a 35-year-old woman with psychogenic palatal myoclonus. She had an acute onset of palatal movements after an uncomplicated rhinoplasty surgery. The repetitive movements of the soft palate completely stop with distraction. Duration: 0:47 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(4):1121-1140, August 2019 Published on: 08.02.2019
Speech examination in a woman with primary progressive apraxia of speech. Legend: Video shows a 70-year-old woman with primary progressive apraxia of speech. Speech alternating motion rates are slow but reasonably accurate. When combining sounds during speech sequential motion rates, a slow rate is required for accurate enunciation. During word repetition, evidence of groping, distortions, and substitutions is seen. This patient had minimal intelligible verbal output during picture description but tested normally on all language measures when written responses were allowed (not shown on video). Duration: 2:02 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(1):101-127, February 2019 Published on: 02.01.2019
Language examination in a woman with nonfluent/agrammatic variant primary progressive aphasia. Legend: Video shows a 68-year-old woman with nonfluent/ agrammatic variant primary progressive aphasia. Agrammatic and telegraphic speech is evident in response to a simple question (“Why are you here?”) and during picture description. Specifically, the first sentence in her response is clearly agrammatic: “Well, I not say the words.” She also omits and and incorrectly uses is when she describes the couple as: “The mother dad is picnicking.” Also, notice the presumed omission during the final sentence: “The radio is probably music.” Duration: 2:18 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(1):101-127, February 2019 Published on: 02.01.2019
Language examination in a man with semantic variant primary progressive aphasia Legend: Video shows a 68-year-old man with semantic variant primary progressive aphasia. During picture description the patient uses a nonspecific word in several instances, such as something for wine, flower thing for kite, over there for dock, and something for sand. When reading irregular words, he regularizes the word in several instances (surface dyslexia). During object naming, he first calls a screwdriver a pen, and, even after holding it, he cannot name it. He does not benefit from a phonetic cue and appears not to recognize the object. Duration: 2:22 Associated with: CONTINUUM: Lifelong Learning in Neurology. 25(1):101-127, February 2019 Published on: 02.01.2019
Percussion Myotonia Legend: Note the delay in relaxation of the third finger after percussion of the forearm muscles in this 44-year-old man with myotonic dystrophy type 1. Duration: 0:24 Associated with: CONTINUUM: Lifelong Learning in Neurology. 22(6):1803-1814, December 2016 Published on: 05.15.2018
Synkinesia After Right Facial Nerve Palsy Legend: Blinking cause co-contraction of the corner of the mouth and smiling causes co-contraction of the orbicularis oculi due to aberrant facial nerve regeneration in this 55-year-old woman. Duration: 0:38 Associated with: CONTINUUM: Lifelong Learning in Neurology. 23(2):333-334, April 2017 Published on: 11.10.2017
Gowers Sign Legend: A 5-year-old boy with Duchenne muscular dystrophy demonstrating the Gowers sign. Notice how he “climbs on himself” to stand up. Duration: 0:34 Associated with: CONTINUUM: Lifelong Learning in Neurology. 22(6):1852-1870, December 2016 Published on: 11.10.2017
Scapular Winging Legend: When asked to abduct her arms over her head, this 65-year-old woman with facioscapulohumeral muscular dystrophy is only able to abduct about 70 degrees with prominent posterior winging of her scapula. Her deltoid muscles are preserved. Duration: 0:28 Associated with: CONTINUUM: Lifelong Learning in Neurology. 22(6):1815-1828, December 2016 Published on: 11.10.2017
Beevor Sign Legend: A 50-year-old man with facioscapulohumeral muscular dystrophy lies on his back with his head to the left. When lifts his head, the asymmetric involvement of his abdominal musculature causes the umbilicus to be pulled in the direction of the unaffected muscles. Duration: 0:28 Associated with: CONTINUUM: Lifelong Learning in Neurology. 22(6):1815-1828, December 2016 Published on: 11.10.2017
Myotonic Discharges Legend: Myotonic discharges on EMG wax and wane in frequency and amplitude. Acoustically, this has been described as sounding like a dive-bomber. Duration: 0:44 Associated with: CONTINUUM: Lifelong Learning in Neurology. 22(6):10.1212/01.CON.0000511063.45770.8c, December 2016 Published on: 11.10.2017
Progressive Supranuclear Palsy–Parkinsonism Legend: A 65-year-old man with hypophonic and dysarthric speech and masked facial expression. Vertical saccades are reduced and horizontal saccades slowed. He has moderate bradykinesia of hand movements, finger tapping, and rigidity in the limbs. Gait is stooped and slow, and his stance is narrowed and unstable. Pull test reveals minimal to no compensation. Duration: 4:03 Associated with: CONTINUUM: Lifelong Learning in Neurology. 22(4):1117-1142, August 2016 Published on: 11.10.2017
Corticobasal Degeneration Legend: An 80-year-old man demonstrating progressive asymmetric limb dysfunction, rigidity, bradykinesia, dystonia, apraxia, and cortical sensory deficits consistent with probable corticobasal degeneration. Duration: 6:47 Associated with: CONTINUUM: Lifelong Learning in Neurology. 22(4):1117-1142, August 2016 Published on: 11.10.2017
Multiple System Atrophy–Parkinsonism Legend: A 66-year-old man demonstrating hypokinetic dysarthric speech, jaw-opening dystonia, atypical tremor, symmetric rigid bradykinesia, and early postural instability consistent with multiple system atrophy–parkinsonism. Duration: 3:59 Associated with: CONTINUUM: Lifelong Learning in Neurology. 22(4):1117-1142, August 2016 Published on: 11.10.2017
Psychogenic Nonepileptic Seizure Induced by Photic Stimulation and Verbal Suggestion Legend: The documented features of suggestibility (intensifying ictal manifestations with increasing photic frequency), somatic expression of distress (coughing, semifetal posture), and clinical unresponsiveness despite EEG demonstration (not shown) of an intact posterior dominant rhythm (reflecting an awake state) are all supportive of a psychogenic etiology to this captured nonepileptic seizure. Duration: 2:18 Associated with: CONTINUUM: Lifelong Learning in Neurology. 22(1):15-37, February 2016 Published on: 11.10.2017
Relative Median Nerve and Tendon Movement With Wrist and Finger Flexion Legend: Duration: 1:28 Associated with: October 2017, Volume 23, Issue 5; Published on: 11.09.2017
Axial (Short Axis) Video of the Biceps in a Patient With Amyotrophic Lateral Sclerosis Legend: Duration: 0:42 Associated with: October 2017, Volume 23, Issue 5; Published on: 11.09.2017
Dynamic Scan of Transected Posterior Interosseus Nerve (PIN) Legend: Duration: 0:48 Associated with: October 2017, Volume 23, Issue 5; Published on: 11.09.2017
The Median Nerve in Cross Section as the Probe is Moved From the Wrist to the Antecubital Fossa in a Patient With Charcot-Marie-Tooth Disease Type 1A Legend: Duration: 1:09 Associated with: October 2017, Volume 23, Issue 5; Published on: 11.09.2017
Video and Still Image Contrasting the Median Nerve in a Healthy Patient With the Median Nerve in a Patient With Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP) Legend: Duration: 2:00 Associated with: October 2017, Volume 23, Issue 5; Published on: 11.09.2017
Neuromyotonia Legend: EMG recording from a middle-aged man includes multiple repeating discharges, each composed of multiple muscle fiber potentials with varying interpotential intervals corresponding to a firing frequency of up to 200 Hz. Duration: 0:37 Associated with: October 2017, Volume 23, Issue 5; Published on: 11.09.2017
Myokymia in a Patient With Morvan Syndrome Legend: A 45-year-old woman with Morvan syndrome, with myokymia predominantly involving her platysma. Duration: 0:41 Associated with: October 2017, Volume 23, Issue 5; Published on: 11.09.2017
Mildly abnormal intracranial pressure (ICP) waveform. Legend: 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. Duration: 2:23 Associated with: CONTINUUM: Lifelong Learning in Neurology. 21(5):1299-1323, October 2015 Published on: 10.07.2015
Low compliance and high elastance Legend: 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. Duration: 2:22 Associated with: CONTINUUM: Lifelong Learning in Neurology. 21(5):1299-1323, October 2015 Published on: 10.07.2015
Acute dissociation and functional facial spasm Legend: 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. Duration: 0:34 Associated with: CONTINUUM: Lifelong Learning in Neurology. 21(3):818-837, June 2015 Published on: 06.10.2015
Right lower facial spasm Legend: 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. Duration: 0:37 Associated with: CONTINUUM: Lifelong Learning in Neurology. 21(3):818-837, June 2015 Published on: 06.10.2015
Right leg Hoover sign. Legend: 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. Duration: 0:42 Associated with: CONTINUUM: Lifelong Learning in Neurology. 21(3):818-837, June 2015 Published on: 06.10.2015
Tremor entrainment test. Legend: 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. Duration: 1:04 Associated with: CONTINUUM: Lifelong Learning in Neurology. 21(3):818-837, June 2015 Published on: 06.10.2015
Improvement of balance disorder with distraction. Legend: This video shows a patient who presents acutely with falls and unsteadiness on standing. She describes dissociation during the falls and is unsteady when standing, but she becomes stable when testing eye movements. Duration: 1:42 Associated with: CONTINUUM: Lifelong Learning in Neurology. 21(3):818-837, June 2015 Published on: 06.10.2015
Functional left hemiparesis. Legend: 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. Duration: 1:46 Associated with: CONTINUUM: Lifelong Learning in Neurology. 21(3):818-837, June 2015 Published on: 06.09.2015
Bilateral functional dystonia. Legend: This video shows a patient with long-standing bilateral functional dystonia of both legs with characteristic internal hip rotation and ankle inversion. Duration: 0:34 Associated with: CONTINUUM: Lifelong Learning in Neurology. 21(3):818-837, June 2015 Published on: 06.09.2015
Therapeutic sedation. Legend: This video shows two patients, the first with triplegia and the second with fixed dystonia, undergoing successful therapeutic sedation with propofol. Duration: 1:47 Associated with: CONTINUUM: Lifelong Learning in Neurology. 21(3):818-837, June 2015 Published on: 06.09.2015
Mild Diplopia in Myasthenia Gravis Legend: 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. Duration: 1:26 Associated with: CONTINUUM: Lifelong Learning in Neurology. 20(5):1413-1425, October 2014 Published on: 10.24.2014
Diplopia on Upgaze in Myasthenia Gravis Legend: An 84-year-old man who has had myasthenia gravis for 3 years. Examination demonstrates horizontal diplopia that develops on upgaze. Duration: 0:50 Associated with: CONTINUUM: Lifelong Learning in Neurology. 20(5):1413-1425, October 2014 Published on: 10.24.2014
Weak Eyelid Closure in Myasthenia Gravis Legend: An 84-year-old man who has had myasthenia gravis for 3 years. Examination demonstrates mild weakness of forced eyelid closure Duration: 0:39 Associated with: CONTINUUM: Lifelong Learning in Neurology. 20(5):1413-1425, October 2014 Published on: 10.24.2014
Edrophonium (Tensilon) Test in Myasthenia Gravis Legend: 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. Duration: 2:06 Associated with: CONTINUUM: Lifelong Learning in Neurology. 20(5):1413-1425, October 2014 Published on: 10.24.2014
