Video Gallery

192 Videos

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

Recent Videos

Chorea-acanthocytosis
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
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
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
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
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 tardive dystonia
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

Mild, segmental tardive dystonia with associated tachypnea
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

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

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