Dizziness-and-Balance Site Movies

Timothy C. Hain, MD • Page last modified: May 10, 2023.

https://dizziness-and-balance.com is a large graphics rich site, best viewed on a fast connection. At this writing, there are approximately 2500 files, 500 pages, 75 anatomic or disease related images, and about 150 movies. Using equipment described on this page, we have recorded eye-movies of every patient that we saw in our dizziness clinic between 2005 and 2023. We also have posted movies of patients of another otoneurologist, Dr. Dario Yacovino, in Argentina. For those of you who have movies you would like to post, after review, we are also willing to post your eye movies.

Most of these movies are "mp4" files.

BPPV related movies include:

1. Posterior canal (PC) BPPV
   1. bppv.mp4 (nystagmus of PC BPPV)
   2. MMT DIX-HALLPIKE RIGHT (a recording of R BPPV from a vendor's hardware)
   3. bppv dix-hallpike.mp4 (dix-hallpike maneuver live)
   4. Brandt-Daroff.mp4 (home treatment of PC BPPV)
   5. Semont.mp4 (treatment maneuver for PC BPPV)
   6. Hallpike-Dix.mp4 (diagnostic maneuver for PC BPPV )
   7. Epley.mp4 (treatment maneuver for PC BPPV)
   8. Debris-Redistribution.gif (canalithiasis mechanism)
2. Lateral Canal (LC) BPPV
   1. HC BPPV.mp4 (Lateral canal BPPV, geotropic variant, courtesy of Dr. Dario Yacovino.
   2. lateral canal BPPV ageotrophic variant
   3. log roll2.mp4 (home treatment for lateral canal BPPV)
3. Anterior Canal BPPV (AC)
   1. acbbpv-short.mp4 (Anterior canal BPPV nystagmus)
4. Cervical Vertigo -- Cervical vertigo is multifactorial, and the videos below show several types of nystagmus provoked by neck stimulation. This is a graphic proof of the existence of cervical vertigo.
   1. disk disease
   2. vat.mp4 -- vertebrobasilar insufficiency • Description of VBI case
   3. Increased COR (cervical ocular reflex) in person with bilateral vestibular loss. This is a big one.
   4. Also see movies of neck vibration induced nystagmus such as this one -- vibration acoustic
   5. Vertebral artery compression due to an osteophyte (Dr. Yacovino)

Meniere's disease and Vestibular neuritis movies include:

1. Menieres.mp4
2. vnsmall.mp4 . Vestibular neuritis at day 7
3. vn(1).mp4 . Vestibular neuritis at day 1
4. itg.mp4 -- nystagmus after intratympanic gentamicin See also case page -- ttg
5. wrong-way-- wrong way nystagmus in acute Meniere's. See also case page wrong way

Bilateral Vestibular loss and Gentamicin Ototoxicity

1. bilatfunclos
2. Increased COR (cervical ocular reflex)

Congenital Nystagmus

1. Jerk type congenital nystagmus with and without fixation
2. Jerk type Congenital nystagmus during fixation and then in dark (listen for click).
3. PAN type congenital nystagmus
4. latent.mp4 (Latent nystagmus)
5. Torsional CN (fixation only)
6. Circular pattern CN
7. Congenital nystagmus in the author's white cat.

Examination results for unilateral vestibular loss:

1. vibration acoustic. Demonstration of vibration induced nystagmus in person with unilateral vestibular loss
2. head-shaking nystagmus (61 meg). Demonstration of head-shaking nystagmus in person post-gentamicin injection for Meniere's disease.
3. Head-shaking nystagmus in vestibular neuritis, courtesy of Dr. Dario Yacovino (Argentina).

Pressure sensitivity and related conditions -- these mainly show torsional nystagmus induced by pressure in SCD, but there is also an example of horizontal nystagmus in a patient who had fenestration of the horizontal canal (an old operation for otosclerosis).

1. tullio.mp4 (strong nystagmus elicited by sound -- superior canal dehiscence, 33 meg)
2. tullio L SCD.mp4 (very subtle torsional nystagmus elicited by sound -- superior canal dehiscence, 11 meg)
3. pressure.mp4 (nystagmus elicited by pressure -- fistula, 49 meg)
4. fistula test 2.mov -- nystagmus elicited by pressure in person with R SCD (courtesy of Dr. Dario Yacovino).
5. Valsalva Tests
   1. Valsalva L SCD.mp4 (Valsalva induced ocular torsion in superior canal dehiscence)
   2. nystagmus elicited by Valsalva in person with R Superior Canal Dehiscence
   3. Valsalva Fenestration.mp4 (Valsalva induced horizontal nystagmus in patient post fenestration surgery, 13.730 meg)
   4. Positive and then negative valsalva, attributed to response to conservative treatment for fistula (thanks to Dr. Dario Yacovino).
6. Pulse synchronous nystagmus
   1. Same case as above (R superior canal)
   2. Another case of pulse synchronous nystagmus

Central nystagmus

1. Alexanders law.mp4 (Alexander's law, 12 meg)
2. Downbeating nystagmus
   1. downbeating.mp4 (6 meg)
   2. downbeating increased on prone
   3. Downbeating nystagmus in patient with MS.
   4. Paraneoplastic nystagmus (DBN and gaze) in patient with anti-Yo
   5. Paraneoplastic cerebellar degeneration -- downbeating nystagmus in lateral gaze
3. Gaze-evoked nystagmus (courtesy of Dr. Dario Yacovino)
4. Internuclear ophthalmoplegia in MS
5. Periodic alternating nystagmus
   1. Periodic alternating nystagmus (90 meg) acquired type
6. upbeating.mp4
7. torsional nystagmus
8. rebound bm.mp4 (Rebound nystagmus), Rebound in patient with SCA-6 (courtesy of Dr. Dario Yacovino).
9. Saccadic nystagmus
   1. Voluntary nystagmus (high video resolution and speed is absolutely necessary to see VN)
   2. Opsoclonus
   3. Ocular flutter under closed eyelids (courtesy of Dr. Dario Yacovino).
   4. Square wave jerks
   5. Macro square wave jerks (paraneoplastic).
10. Pendular nystagmus in oculopalatal myoclonus (6 meg)
11. vertical pendular nystagmus (from pontine hemorrhage).
12. Slow vertical saccades in PSP.
    1. Slow vertical saccades in patient with PSP
    2. Another example of slow vertical saccades in PSP
13. Saccadic dysmetria
    1. Saccadic dysmetria
    2. Overshoot dysmetria after a bleed into deep cerebellar nuclei (fastigial nucleus lesion)
14. Superior oblique myokymia (SOM, 1 meg)

Cranial nerve palsies and muscle disorders

1. Sixth nerve palsy
2. Global saccadic paresis in Kearn Sayre syndrome.
   1. (peo2.mp4 -- 3 meg)
   2. peo with ragged red fibers.mp4
3. Bell's phenomenon (8 meg). Video Frenzel goggles can easily show the characteristic up rolling of the eyes that occurs in peripheral facial nerve palsy (Bell's palsy).

Basic physiology/Anatomy animations (this section is under construction) include:

1. Hearing animation.gif
2. Middle-Ear-Pressure.gif
3. Outer-middle-inner-ear.gif
4. Vestibular nerve.gif
5. Vestibule and canals.gif

Miscellaneous movies

1. Palatal myoclonus of throat (not eye). For eye see "pendular nystagmus in oculopalatal myoclonus" above.
   1. pm_gb.mp4 (14 meg)
   2. pm.mp4 (6 meg)
2. hvt small.mp4 (15 meg) Hyperventilation induced nystagmus in person with left sided acoustic neuroma. This is a rather long (1.5 minute) clip.
3. Spinal fluid in ear ventilation tube (1.5 meg). This short movie is courtesy of Dr. Richard Wiet. It shows spinal fluid from a leak into the middle ear, pulsating in a PE tube. It is very dramatic.
4. Rotatory Chair in motion.
5. Vertebral artery compression due to an osteophyte
6. Rapid (3hz) torsional nystagmus

Other interesting content:

1. Audio recording of stapedius myoclonus. This type of tinnitus can be also heard by the examiner (as long as you put your ear close to the patient's ear).

Most of these are mp4 files which are are digitized movies of eye movements or treatment procedures. Most of them are 320/240 in size, some are larger, and intended for slide presentations. The "gif" files are large animated gifs.

Legal stuff:

The intent of this site is to disseminate information about otoneurology. Dr. Hain retains the copyright to this material. Noncommercial use of graphics and movies is permitted and encouraged (with attribution to the source). In other words -- you do not need to contact me to use this material in your lecture ! If you put this in your web page, please link and attribute the source (i.e. this web site) so you don't break the law.

Please attribute the source by providing the address of the webpage from which the image or video was copied, and the date downloaded.