Patient looks straight ahead: mainly horizontal spontaneous nystagmus beating to the left. Cover test (10 seconds): skew deviation, left eye above the right eye, typical of one of the components of the ocular tilt reaction. 40 seconds: Alternating cover test shows the maximum angle of skew deviation. 52 seconds: Convergence reaction normal. 57 seconds: Looking for gaze-evoked nystagmus, looking to the right, upward, to the left (1 minute 8 seconds) and downward (1 minute 18 seconds). Showing the spontaneous nystagmus beating to the left. Smooth pursuit (1 minute 30 seconds): saccadic, in particular to the left. Also vertically saccadic (1 minute 40 seconds). Examination of saccades (1 minute 50 seconds): hypermetric to the right and hypometric to the left, typical finding in Wallenberg’s syndrome. Vertical saccades (2 minutes): lateropulsion to the right when looking upward, typical of right-sided Wallenberg’s syndrome. Determination of subjective visual vertical (2 minutes 33 seconds) shows a clear deviation of the subjective visual vertical to the right, another component of the ocular tilt reaction to the right. Examination in darkness shows the spontaneous nystagmus to the left and the myosis on the right side with a slight ptosis, typical of right-sided Horner syndrome.
When looking straight ahead, there is a mainly torsional nystagmus upper pole beating to the right. When examining the patient with Frenzel’s glasses (25 seconds), the Horner syndrome on the left and the skew deviation with the left eye below the right eye can also be better seen. 38 seconds: This is a typical central fixation nystagmus which cannot be suppressed by visual fixation. Cover test (48 seconds) reveals that the left eye is below the right eye, i.e. a skew deviation. The maximum angle of eye deviation can be identified by the alternating cover test (1 minute). 1 minute 15 seconds: There is a strong tendency of the patient to fall to the left, typical of a left-sided Wallenberg’s syndrome with strong lateropulsion.