As a medical student, my prof could spend a hour explaining this and yet I still don't understand it. Dr. Lee can do it in 4. No BS straight to the point. Love it.
I love how Dr Lee smirks, turns and walks away from the board at the end of most videos - like an action hero walking away from an explosion behind him! No doubt, Neuro-op is kickass enough to warrant that.
It is ridiculous how easy you made this concept. TWO LONG WEEKS trying to get my head around this, and it only took me 3 minutes to completely understand this. I cannot be more THANKFUL Dr. Lee you're an amazing human being. ❤ May God continue to bless you always!!!!!!!
Dr.Lee your residents and students are so lucky to have such an amazing professor like you, sir. I wish I could have a professor like you, I wouldn't have to quit ophthalmology residency in my home country. It's a pleasure to listening valuable concepts from you.
My sister and I met you at the Ophthalmology Conference in South Africa and you encouraged us to watch your videos and drop you a comment... So here I am.. saying that Dr Lee, you are amazing!
Just perfect! I saw my first case of INO in a patient and I couldn't really grasp the concept. Everything was so clearly explained in only a four minute video. Thank you!
I was convinced that convergence was always spared with INO, so I was confused when I had a patient who could not converge. Now I know the problem was located in the thalamo-mesencephalic junction! Thank you !
Thanks Dr Lee, this video was very helpful! Also don't forget that anterior and posterior INOs can also have bilateral lesions, giving slightly extra symptoms :)
In case someone has the same difficulty; there's this point that confused me and still does because of the inconsistency of anatomical labeling (if want to call it that) which seems random and arbitrary in medical teaching, where they just say right and left (in some cases to be fair) when it does not make any sense.. Left and right, in neuro-anatomy at least, is always concerned with the side that the structure starts in (as far as I remember! please correct me if I'm wrong), but here in this example, the "RIGHT" MLF is meant to be : The MLF that "GOES" to the right side, although it's the one that was sent by the "LEFT" PPRF or "LEFT" VI Abducent nerve. The anatomical labeling of it is "RIGHT" and does not respect the fact that it started in the "LEFT" side and is meant to help the "LEFT" eye bring the opposite eye to do the same movement (conjugate), it is not in respect to that but rather to where it's going. Is this due to the fact that most lesions occur in the portion after it "decussates" to the contra lateral side (the eye which it is supposed to innervate) or in other words is it because the MLF was reduced to just the "longitudinal" part which happens to be on the contra lateral side? This means that when a lesion in the so-called "RIGHT" MLF (the one coming from LEFT CN-VI) is gonna fall short of accomplishing its mission of (conjugating the RIGHT eye's movement with LEFT eye which is intending to ABDUCT [ look laterally or left in this case ] ) i.e. failure of "ADDUCTING" the "RIGHT" eye. PHEWww... Now I get it! lol!
Thank you, I've been rewatching this video for the last 30 mins, trying to understand why Dr. Lee is seemingly contradicting himself in his clinical conclusion, despite initially giving the correct explanation.
1:18 If by the right MLF lesion, you mean left MLF lesion, then yes. Damage to the right MLF (i.e., the MLF originating in the right CN VI) would result in failure to adduct the contralateral (left) eye. If I'm wrong, please someone explain how.
It seems that most sources say that in an MLF lesion, there will be ipsilateral loss of adduction, but ChatGPT suggests that there will be contralateral loss of adduction in MLF lesions. For me, logically, it doesn't make sense that in an MLF lesion, there would be ipsilateral loss of adduction. When we need to look to the left or right, the lateral rectus of one eye and the medial rectus of the other eye must coordinate so that both eyes move in sync. This is exactly the purpose of the MLF. The MLF coordinates the abduction of one eye with the adduction of the other. The key point to note is that the primary event is abduction, not adduction, as even Sir has used the arrows in this way. The good thing is that neither the third nor the sixth nerve crosses. Maybe we just got lucky, or perhaps scientists who study these things wanted us to study somewhat simpler concepts at the MBBS level. The point is that the sixth nerve originates from a more caudal part of the brain than the third nerve. The more caudal the nucleus, the less conscious we are of it, and the more ancient that part of the brain is. When we need to look left, the signal to look left will originate in the left sixth nerve nucleus, not the right third nerve nucleus. This means the primary event is abduction, followed by adduction. By this logic, if I want to look left, my left lateral rectus will move my left eye to the left. However, to also move the right eye to the left, the right medial rectus must contract (adduct). If the MLF is damaged, the right eye will not be able to adduct. The primary signal for abduction of the left eye remains intact, so ipsilateral abduction is spared. However, if the MLF is damaged, the secondary signal for adduction of the contralateral eye does not occur. Therefore, in an MLF lesion, the contralateral medial rectus cannot function. If anybody has any insights, please enlighten me.
If it helps, I've made a INO animation on my channel with subtitles. Covers BINO, WEBINO, one and half syndrome, half and half syndrome and the Posterior INO of Lutz
Dr. Lee is legitimately so talented to make me feel I understand something in 4 minutes.
Now INO how INO works. Thank you!
Something like the thinman am I right!?
😂u sure do
As a medical student, my prof could spend a hour explaining this and yet I still don't understand it. Dr. Lee can do it in 4. No BS straight to the point. Love it.
I love how Dr Lee smirks, turns and walks away from the board at the end of most videos - like an action hero walking away from an explosion behind him! No doubt, Neuro-op is kickass enough to warrant that.
It is totally a well-earned “mic-drop boss” moment.. thank you Dr Lee, you are transforming Neuro-ophthalmology a fascinating area of study for me
Dr.Lee I see passion in you
You are my inspiration
It is ridiculous how easy you made this concept. TWO LONG WEEKS trying to get my head around this, and it only took me 3 minutes to completely understand this. I cannot be more THANKFUL Dr. Lee you're an amazing human being. ❤ May God continue to bless you always!!!!!!!
Dr.Lee your residents and students are so lucky to have such an amazing professor like you, sir. I wish I could have a professor like you, I wouldn't have to quit ophthalmology residency in my home country. It's a pleasure to listening valuable concepts from you.
Hocam sizi ne bıktırdı hastalar mı hastane mi hocalar mı
How and where I can see Dr.Lee?
For the longest time in internal medicine I was trying to figure this out. This was so simply explained and to the point, loved it. Thank you!
My sister and I met you at the Ophthalmology Conference in South Africa and you encouraged us to watch your videos and drop you a comment... So here I am.. saying that Dr Lee, you are amazing!
Just perfect! I saw my first case of INO in a patient and I couldn't really grasp the concept. Everything was so clearly explained in only a four minute video. Thank you!
I could understand INO in comprehensive way only after watching this video 5yrs back..
Thank you so much sir🙏
Now I'm sharing this with my juniors
I was convinced that convergence was always spared with INO, so I was confused when I had a patient who could not converge. Now I know the problem was located in the thalamo-mesencephalic junction! Thank you !
Wonderfull, differentiating between the midbrain and pons is an excellent pointer , never thought about it. Thank you
OH MY GOODNESS!!. DR LEE IS LEGIT. how easily are you explaining this. Subscribed!
Amazing video that simplifies a difficult topic. Thank you doctor!
The best explanation ever! So simple. Thank you!
Studying for my medical school neuro exam and this video was SO helpful -- Thank you!!!
The best explanation of INO out there. Thanks
Dr. Lee thank you for an incredible and clear explanation.
Literally the best!! Thank you doctor Andrew
Incredible, such a good explanation.
That INO breakdown was legit
You're a great teacher. Thank you!
You have made it a lot easier to understand. Thanks for the informative videos
Excellent presentation doctor thanks a lot god bless you best wishes
Beautiful explaination!
That was truly a mic drop moment at the end of this vid. Well taught
Many thanks Dr. Lee
Studying for Step 1 and I just couldn’t figure this out. Thank you!
Fantastic teaching video , thank you Dr. Lee
Excellent explanation.
Fantastic explanation!! Thank you!
This man is so addictive
You can’t stop watching
I am at the end of my neurology studies. Dear D.r Lee you help me so much Thank you very much.
Simplified explanation. Thank you so much!
Bless you, sir, for your thoroughness.
Dr. Lee is so enthusiastic!
Doc is an excellent teacher
Thanks Dr Lee, this video was very helpful! Also don't forget that anterior and posterior INOs can also have bilateral lesions, giving slightly extra symptoms :)
Super easy explanation, thanks a bunch Dr
Indeed
Dr. Lee, thank you so much.
What an absolute baller, I like his excitement too! 1 day before step 1 but im getting sucked into his youtube wormhole...
Amazing explanation thank you so much 👏
These videos are gold, thank you!
no one can teach better than this,thank u
big fan sir. love from india.
Thank you Doctor Lee!!
GENIUS THANK YOU DOCTOR
thanks Dr. Lee you're such a great help! your vids are amazing!
Thank you Dr. Lee
This is How to give explanation 🔥😍
It's a great explanation!Thank you so much!
In case someone has the same difficulty; there's this point that confused me and still does because of the inconsistency of anatomical labeling (if want to call it that) which seems random and arbitrary in medical teaching, where they just say right and left (in some cases to be fair) when it does not make any sense..
Left and right, in neuro-anatomy at least, is always concerned with the side that the structure starts in (as far as I remember! please correct me if I'm wrong), but here in this example, the "RIGHT" MLF is meant to be : The MLF that "GOES" to the right side, although it's the one that was sent by the "LEFT" PPRF or "LEFT" VI Abducent nerve. The anatomical labeling of it is "RIGHT" and does not respect the fact that it started in the "LEFT" side and is meant to help the "LEFT" eye bring the opposite eye to do the same movement (conjugate), it is not in respect to that but rather to where it's going. Is this due to the fact that most lesions occur in the portion after it "decussates" to the contra lateral side (the eye which it is supposed to innervate) or in other words is it because the MLF was reduced to just the "longitudinal" part which happens to be on the contra lateral side?
This means that when a lesion in the so-called "RIGHT" MLF (the one coming from LEFT CN-VI) is gonna fall short of accomplishing its mission of (conjugating the RIGHT eye's movement with LEFT eye which is intending to ABDUCT [ look laterally or left in this case ] ) i.e. failure of "ADDUCTING" the "RIGHT" eye.
PHEWww... Now I get it! lol!
Thank you, I've been rewatching this video for the last 30 mins, trying to understand why Dr. Lee is seemingly contradicting himself in his clinical conclusion, despite initially giving the correct explanation.
Impossible says I am possible ... Thanks to Dr Lee
Dr lee thank you! You are amazing
You’re so good at explaining
Excellent!
best explanation ever
Oh my God. Wonderful
So fast, so good. Thank you!
Dr lee thank you
Thank u 😃 from iraq
How is your Iraq Saradocter
1:18 If by the right MLF lesion, you mean left MLF lesion, then yes. Damage to the right MLF (i.e., the MLF originating in the right CN VI) would result in failure to adduct the contralateral (left) eye. If I'm wrong, please someone explain how.
great Sir, thank you
really thanks Prof Andy
wow. you made it so simple'
So "febrile" - very nice - thank you
what is the treatment doc asking from kenya
Thank you so much Dr. Lee. Your explanation is always clear and easy to comprehend.
YOU ARE AMAZING! THANK YOU
Thanks ..so perfect❤
amazing
thank you
You are AMAZING
That's great. Still don't understand the direction of the nystagmus. Can anyone help?
THIS IS LEGENDARY
Thank you nice explanation
Are you taking new patients? I would be curious about treatment solutions?
Incredible
V good explanation
Can you explain to us please how we can differentiate between anterior Vs posterior INO
Thank you very much
Thanks, very well explained.
Paresis = weakness (Partial Paralysis)
Plegia = Total Paralysis
Is this treatable with vision therapy or
super good explanation!
So amazing
thank you very much
Thank you Lee
Genius 😳
THANK YOU SO MUCH!!!!
ماشاء الله 🙏
it is truly helpful!! awesome!! Thanks a lot.
Is there are cure for it Dr?
Thank you!
It seems that most sources say that in an MLF lesion, there will be ipsilateral loss of adduction, but ChatGPT suggests that there will be contralateral loss of adduction in MLF lesions.
For me, logically, it doesn't make sense that in an MLF lesion, there would be ipsilateral loss of adduction.
When we need to look to the left or right, the lateral rectus of one eye and the medial rectus of the other eye must coordinate so that both eyes move in sync. This is exactly the purpose of the MLF. The MLF coordinates the abduction of one eye with the adduction of the other. The key point to note is that the primary event is abduction, not adduction, as even Sir has used the arrows in this way.
The good thing is that neither the third nor the sixth nerve crosses. Maybe we just got lucky, or perhaps scientists who study these things wanted us to study somewhat simpler concepts at the MBBS level.
The point is that the sixth nerve originates from a more caudal part of the brain than the third nerve. The more caudal the nucleus, the less conscious we are of it, and the more ancient that part of the brain is. When we need to look left, the signal to look left will originate in the left sixth nerve nucleus, not the right third nerve nucleus. This means the primary event is abduction, followed by adduction.
By this logic, if I want to look left, my left lateral rectus will move my left eye to the left. However, to also move the right eye to the left, the right medial rectus must contract (adduct). If the MLF is damaged, the right eye will not be able to adduct. The primary signal for abduction of the left eye remains intact, so ipsilateral abduction is spared. However, if the MLF is damaged, the secondary signal for adduction of the contralateral eye does not occur. Therefore, in an MLF lesion, the contralateral medial rectus cannot function.
If anybody has any insights, please enlighten me.
Thank you
Please add description to the explanation it will help more sir
If it helps, I've made a INO animation on my channel with subtitles. Covers BINO, WEBINO, one and half syndrome, half and half syndrome and the Posterior INO of Lutz
I've been suffering of this type of sickness since 2005.. Pls tell me how can avoid this.
I love watching this shit when I'm stoned and wearing 3d glasses 👓
you are a legend