Summary
The results of eleotro-oculographic recordings made after caloric vestibular stimulation (C.O.G.) in severe head injured patients are discussed. It was found that:
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1.
The C.O.G. correlates with the state of consciousness of the patients.
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The rate of improvement of the C.O.G. correlates with the rate of the clinical improvement.
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3.
A prediction of the duration of unconsciousness can be made by repeated C.O.G. scores as well as by repeated scoring of the clinical state.
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In all patients a paradoxical response is present except in those who have regained clear consciousness and in those persisting in a vegetative state, so the presence of a paradoxical response indicates the possibility of further improvement.
It was supposed that in patients with a paradoxical response a functional brain dysfunction was present, which was at least partly caused by disturbed neurotransmitter metabolism. Therapeutic trials with L-DOPA and physostigmine were successful in patients with a paradoxical response, but without any result in those without this phenomenon. The responses to L-DOPA and to physostigmine are related respectively to motor pattern and to verbal or non-verbal communication.
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Minderhoud, J.M., van Woerkom, T.C.A.M. & van Weerden, T.W. On the nature of brain stem disorders in severe head injured patients. Acta neurochir 34, 23–35 (1976). https://doi.org/10.1007/BF01405860
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DOI: https://doi.org/10.1007/BF01405860