Video Gallery

156 Videos

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

Speech examination in a woman with primary progressive apraxia of speech.
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.
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
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

Progressive Supranuclear Palsy–Parkinsonism
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

Psychogenic Nonepileptic Seizure Induced by Photic Stimulation and Verbal Suggestion
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

Neuromyotonia
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

Mildly abnormal intracranial pressure (ICP) waveform.
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
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

Edrophonium (Tensilon) Test in Myasthenia Gravis
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

Downbeat nystagmus
Downbeat nystagmus

Legend: This video shows a 67-year-old woman with downbeat nystagmus caused by lithium toxicity. Note that the nystagmus is more prominent with downward and lateral gaze.

Duration: 00:42

Associated with: August 2014, Volume 20, Issue 4;

Published on: 08.15.2014

Upbeat and gaze-evoked nystagmus
Upbeat and gaze-evoked nystagmus

Legend: 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.

Duration: 00:45

Associated with: August 2014, Volume 20, Issue 4;

Published on: 08.15.2014

Torsional nystagmus
Torsional nystagmus

Legend: This video shows a 55-year-old woman with jerk torsional nystagmus following a medullary stroke. The nystagmus is best detected by careful observation of the conjunctival blood vessels or iris.

Duration: 00:30

Associated with: August 2014, Volume 20, Issue 4;

Published on: 08.15.2014

Seesaw nystagmus
Seesaw nystagmus

Legend: This video shows a 44-year-old man with pendular seesaw nystagmus following head trauma. The patient had a dense bitemporal hemianopia and MRI showed an atrophic optic chiasm without evidence of a compressive lesion.

Duration: 00:20

Associated with: August 2014, Volume 20, Issue 4;

Published on: 08.15.2014

Acquired pendular  nystagmus
Acquired pendular nystagmus

Legend: 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.

Duration: 00:34

Associated with: August 2014, Volume 20, Issue 4;

Published on: 08.15.2014

Oculopalatal tremor
Oculopalatal tremor

Legend: 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.

Duration: 00:24

Associated with: August 2014, Volume 20, Issue 4;

Published on: 08.15.2014

Macrosaccadic oscillations
Macrosaccadic oscillations

Legend: 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.

Duration: 00:25

Associated with: August 2014, Volume 20, Issue 4;

Published on: 08.15.2014

Opsoclonus
Opsoclonus

Legend: This video shows a 55-year-old woman with opsoclonus secondary to paraneoplastic brainstem encephalitis. Note that the saccades are back-to-back, without an intersaccadic interval, and multidimensional.

Duration: 00:36

Associated with: August 2014, Volume 20, Issue 4;

Published on: 08.15.2014

Testing of versions in a man with a left orbital apex syndrome.
Testing of versions in a man with a left orbital apex syndrome.

Legend: 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.

Duration: 00:40

Associated with: August 2014, Volume 20, Issue 4;

Published on: 08.15.2014

Alternate cover test reveals a right hyperphoria and exophoria
Alternate cover test reveals a right hyperphoria and exophoria

Legend: 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.

Duration: 00:14

Associated with: August 2014, Volume 20, Issue 4;

Published on: 08.15.2014

Percussion Myotonia
Percussion Myotonia

Legend: 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.

Duration: 0:18

Associated with: CONTINUUM: Lifelong Learning in Neurology. 19(6):1598-1614, December 2013

Published on: 12.31.2013

Warm-Up of Myotonia in Myotonia Congenita
Warm-Up of Myotonia in Myotonia Congenita

Legend: 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.

Duration: 0:46

Associated with: CONTINUUM: Lifelong Learning in Neurology. 19(6):1598-1614, December 2013

Published on: 12.31.2013

Paradoxical Myotonia in Paramyotonia Congenita
Paradoxical Myotonia in Paramyotonia Congenita

Legend: 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.

Duration: 0:26

Associated with: CONTINUUM: Lifelong Learning in Neurology. 19(6):1598-1614, December 2013

Published on: 12.31.2013

Eye-Closure Myotonia
Eye-Closure Myotonia

Legend: 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.

Duration: 0:25

Associated with: CONTINUUM: Lifelong Learning in Neurology. 19(6):1598-1614, December 2013

Published on: 12.31.2013

Reambulation Using Stance Control Knee-Ankle-Foot Orthoses
Reambulation Using Stance Control Knee-Ankle-Foot Orthoses

Legend: 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.

Duration: 0:31

Associated with: CONTINUUM: Lifelong Learning in Neurology. 19(6):1650-1673, December 2013

Published on: 12.31.2013

Progressive Supranuclear Palsy
Progressive Supranuclear Palsy

Legend: 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.

Duration: 1:45

Associated with: CONTINUUM: Lifelong Learning in Neurology. 19(5):1189-1212, October 2013

Published on: 10.31.2013

Progressive Supranuclear Palsy–Parkinsonism
Progressive Supranuclear Palsy–Parkinsonism

Legend: 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.

Duration: 1:47

Associated with: CONTINUUM: Lifelong Learning in Neurology. 19(5):1189-1212, October 2013

Published on: 10.31.2013

Multiple System Atrophy, Parkinsonian Type
Multiple System Atrophy, Parkinsonian Type

Legend: 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.

Duration: 3:52

Associated with: CONTINUUM: Lifelong Learning in Neurology. 19(5):1189-1212, October 2013

Published on: 10.31.2013

Focal Dystonia
Focal Dystonia

Legend: 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.

Duration: 0:40

Associated with: CONTINUUM: Lifelong Learning in Neurology. 19(5):1225-1241, October 2013

Published on: 10.29.2013

Multiple System Atrophy
Multiple System Atrophy

Legend: 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.

Duration: 0:31

Associated with: CONTINUUM: Lifelong Learning in Neurology. 19(5):1225-1241, October 2013

Published on: 10.25.2013

DYT1 Dystonia
DYT1 Dystonia

Legend: 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.

Duration: 0:33

Associated with: CONTINUUM: Lifelong Learning in Neurology. 19(5):1225-1241, October 2013

Published on: 10.25.2013

Corticobasal Syndrome Due to Alzheimer Disease
Corticobasal Syndrome Due to Alzheimer Disease

Legend: Corticobasal syndrome due to pathology-proven Alzheimer disease in a 79-year-old man with a 7-year course of markedly asymmetric parkinsonism with aphasia. Examination at 3 years from onset demonstrates aphasia, severe ideomotor apraxia, left arm dystonia, intermittent myoclonus, and a Babinski response extensor bilaterally.

Duration: 2:23

Associated with: CONTINUUM: Lifelong Learning in Neurology. 19(5):1264-1286, October 2013

Published on: 10.21.2013

Dialysis Encephalopathy
Dialysis Encephalopathy

Legend: A 64-year-old man with end-stage diabetic renal disease who developed delirium and generalized myoclonic movements after his first hemodialysis treatment. His cognitive function returned to baseline and the movements progressively disappeared within a week without desferrioxamine. Subsequent dialysis sessions were deliberately designed at a slower pace to minimize such occurrences.

Duration: 1:06

Associated with: CONTINUUM: Lifelong Learning in Neurology. 19(5):1264-1286, October 2013

Published on: 10.21.2013

History of Vocalizations and Arm Flailing
History of Vocalizations and Arm Flailing

Legend: A 17-year-old boy with a history of vocalizations and arm flailing, which started at 6 years of age, followed by multiple tics, including wrist flexion, feet cracking, throat clearing, shoulder popping, and neck jerking. After a fluctuating course with an almost quiescent 2-year period, neck jerking resurfaced. The movements caused degenerative disc disease and pain. Treatment with aripiprazole helped, but the movements still caused disruption at school and made driving less safe.

Duration: 0:46

Associated with: CONTINUUM: Lifelong Learning in Neurology. 19(5):1287-1311, October 2013

Published on: 10.16.2013

Persistent Tics in Adulthood
Persistent Tics in Adulthood

Legend: 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.

Duration: 1:32

Associated with: CONTINUUM: Lifelong Learning in Neurology. 19(5):1287-1311, October 2013

Published on: 10.16.2013

Spinocerebellar Ataxia Type 12
Spinocerebellar Ataxia Type 12

Legend: A 68-year-old woman with onset of postural and action hand tremor at age 48, progressing slowly to include gait ataxia at age 58, then dementia at age 65. She had a family history of severe tremor in three of her four siblings, her mother, two maternal uncles, and her maternal grandfather. Her examination also revealed appendicular and gait ataxia, titubation, apraxia, paratonia, and dementia. SCA12, a type of dominant ataxia common in India but rare elsewhere, was confirmed by genetic testing.

Duration: 2:04

Associated with:

Published on: 10.15.2013

Friedreich Ataxia
Friedreich Ataxia

Legend: 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.

Duration: 0:52

Associated with: CONTINUUM: Lifelong Learning in Neurology. 19(5):1312-1343, October 2013

Published on: 10.15.2013

Fragile X Tremor-Ataxia Syndrome
Fragile X Tremor-Ataxia Syndrome

Legend: 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.

Duration: 2:05

Associated with: CONTINUUM: Lifelong Learning in Neurology. 19(5):1312-1343, October 2013

Published on: 10.15.2013

Autosomal Recessive Spastic Ataxia of Charlevoix-Saguenay
Autosomal Recessive Spastic Ataxia of Charlevoix-Saguenay

Legend: A 28-year-old woman with early-onset spasticity of lower limbs followed by progressive trunk and limb ataxia, dysarthria, and neuropathy. Note the relatively mild upper limb ataxia compared to the severe involvement of her lower limbs. Eye movement abnormalities include gaze-evoked nystagmus, saccadic pursuit, and dysmetria of saccades.

Duration: 0:57

Associated with: CONTINUUM: Lifelong Learning in Neurology. 19(5):1312-1343, October 2013

Published on: 10.15.2013

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