Oculovestibular Testing

Aka: Oculovestibular Testing, Cold Calorics, Caloric Response, Vestibulo Ocular Reflex, Oculovestibular Reflex

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II. Indications

  1. Comatose patient with suspected Brainstem injury

III. Technique

  1. Examine External Ear canals first to confirm no significant ear Trauma, or Tympanic Membrane Perforation
  2. Patient supine with head at 30 degrees elevation
    1. Isolates input of horizontal semicircular canals
  3. Instill 10-20 ml iced saline or water into auditory canal
    1. Use 20 cc syringe
    2. Use butterfly tubing with needle cut off
    3. Cools mastoid bone and alters endolymphatic flow
    4. Stimulates vestibular nuclei as if head turned rapidly to opposite side

IV. Interpretation: Findings

  1. Nystagmus both eyes slow toward cold, fast to midline (away from cold)
    1. Not comatose
  2. Both eyes tonically deviate toward cold water
    1. Coma with injured cortex, but intact Brainstem
  3. No eye movement
    1. Brainstem injury
  4. Movement only of eye on side of stimulus
    1. Internuclear Ophthalmoplegia
    2. Suggests Brainstem structural lesion

V. Interpretation: By Condition

  1. Normal patient
    1. Nystagmus both eyes slow toward cold, fast to midline (away from cold)
  2. Deep coma (Tonic pupil response)
    1. Eyes will deviate toward the cold water infusion
    2. Rapid correction is slow or absent
  3. Brainstem lesion
    1. Eyes will not deviate on Cold Calorics (no slow or fast component)
  4. Lesion at CN 3 or 6 (or the Medial Longitudinal Fasciculus)
    1. Results in abnormal Cold Calorics depending on the lesion location

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Related Studies

Ontology: Reflex, Vestibulo-Ocular (C0034944)

Definition (MSH) A reflex wherein impulses are conveyed from the cupulas of the SEMICIRCULAR CANALS and from the OTOLITHIC MEMBRANE of the SACCULE AND UTRICLE via the VESTIBULAR NUCLEI of the BRAIN STEM and the median longitudinal fasciculus to the OCULOMOTOR NERVE nuclei. It functions to maintain a stable retinal image during head rotation by generating appropriate compensatory EYE MOVEMENTS.
Definition (CSP) reflexes for maintaining the position of the eyes and body in relation to changes in orientation of the head.
Concepts Clinical Attribute (T201)
MSH D012027
SnomedCT 90906005, 363830000
English Reflex, Vestibulo Ocular, Reflex, Vestibuloocular, Reflexes, Vestibo Ocular, Reflexes, Vestibo-Ocular, Reflexes, Vestibuloocular, Vestibo-Ocular Reflexes, Vestibulo Ocular Reflex, Vestibulo-Ocular Reflex, Vestibuloocular Reflex, Vestibuloocular Reflexes, vestibuloocular reflex, Oculovestibular reflex, vestibulo-oculomotor reflex, oculovestibular reflex, vor, vestibulo ocular reflex, vestibulo-ocular reflex, Reflex, Vestibulo-Ocular, Vestibuloocular reflex, Vestibulo-ocular reflex, Vestibulo-ocular reflex (observable entity), Vestibulo-ocular reflex finding (finding), Vestibulo-ocular reflex finding, VOR
Swedish Reflex, vestibulo-okulär
Czech reflex vestibulookulární
Finnish Vestibulo-okulaarinen heijaste
Russian REFLEKS VESTIBULIARNO-GLAZNOI, VESTIBULIARNO-GLAZNOI REFLEKS, ВЕСТИБУЛЯРНО-ГЛАЗНОЙ РЕФЛЕКС, РЕФЛЕКС ВЕСТИБУЛЯРНО-ГЛАЗНОЙ
Japanese 前庭眼反射, 反射-前庭眼
Italian Riflessi vestibolo-oculari, Riflesso vestibolo-oculare
Croatian REFLEKS, VESTIBULO-OKULARNI
Polish Odruch przedsionkowo-oczny, Odruch przedsionkowo-okoruchowy
Spanish reflejo vestibulocular (entidad observable), reflejo vestibulocular, reflejo oculovestibular (hallazgo), reflejo oculovestibular, hallazgo relacionado con el reflejo oculovestibular (hallazgo), hallazgo relacionado con el reflejo oculovestibular, Reflejo Vestibuloocular
French Réflexe vestibulo-oculaire
German Reflex, vestibulo-okulärer, Vestibulo-okulärer Reflex
Dutch Reflex, vestibulo-oculaire, Vestibulo-oculaire reflex
Portuguese Reflexo Vestíbulo-Ocular
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Caloric response (C0234172)

Concepts Clinical Attribute (T201)
SnomedCT 22280007
English Caloric response, function, caloric responses (physical finding), caloric responses, Caloric response, Caloric response, function (observable entity), Caloric response (function)
Spanish respuesta calórica (entidad observable), respuesta calórica (función), respuesta calórica
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Examination

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