Galvanic vestibular tests in the assessment of coma and brain death

Toglia, Joseph U.; Adam, R.; Stewart, George H.

doi:10.1002/ana.410090314

Cited by 5 publications

(2 citation statements)

References 2 publications

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“…Even in coma, brainstem structures are able to integrate vestibular signals and provide the necessary afferent command to the oculomotor neurons, as is the case when the brain is intact (Toglia et al, 1981;Mueller-Jensen et al, 1987;Buettner, 1992). Integrating and processing of vestibular induced eye movements can only occur when the involved brain stem circuitry is intact.…”

Section: Discussionmentioning

confidence: 94%

Using video-oculography for galvanic evoked vestibulo-ocular monitoring in comatose patients

Schlosser

Unterberg

Clarke

2005

Journal of Neuroscience Methods

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Section: Discussionmentioning

confidence: 94%

Using video-oculography for galvanic evoked vestibulo-ocular monitoring in comatose patients

Schlosser

Unterberg

Clarke

2005

Journal of Neuroscience Methods

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“…Galvanic stimulation of the oculovestibular apparatus through the mastoid process has been advocated as a more precise method of evaluation with fewer limitations and side effects than traditional methods [31]. 9.…”

Section: General Criteriamentioning

confidence: 99%

Analytic Reviews : The Diagnosis of Brain Death in the Adult Patient

Powner

1987

J Intensive Care Med

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The biological tenet upon which brain death is founded is absolute. The brain's inability to undergo cellular division ensures that once individual neurons die they cannot be replaced. Extrapolating this to the total brain, once the entire brain is dead no recovery can occur, and the patient's family can be guaranteed of that fact. The clinician, therefore, is faced primarily with a diagnostic challenge in determining that brain death is indeed present. The components, procedures, and limitations of that diagnostic process in the adult patient are the subjects of this discussion. Natural HistoryA controlled trial incorporating a standardized treatment protocol and addressing the issue of cardiovascular survival after brairi death has never been published. Most earlier literature, however, has taught that spontaneous cardiac arrest usually occurs within 24 to 72 hours and always within two weeks [1-4] after brain death. With current cardiorespiratory support techniques, however, prolonged somatic survival is more common [5], although spontaneous cardiac arrests do occur. Early cardiac failure supports the urgency felt by many physicians to proceed quickly with the diagnosis of brain death, especially when organ removal for donation is a factor. _ Brain death, or coma depasse, has generally been defined as the irreversible cessation of the function of all parts of the brain above the foramen magnum. Cerebral death identifies the permanent loss of function of both cerebral hemispheres and is synonymous with neocortical death. Unfortunately, the terms brain death and cerebral death have.been used interchangeably, but they are not synonymous. Brainstem death has been identified primarily in the British literature as a vital component of brain death and also as a recognizable separate entity that may exist without cerebral death [6,7]. The philosophical and moral positions supporting termination of life support and initiation of organ removal when only cerebral or brainstem function has ceased, as proposed by some [8], are not discussed here. This article is based on the generally accepted medical, legal, and sociological definition of brain death as that requiring loss of all components of the brain. The interested reader is referred tQ the several review articles available regarding the ethical and legal issues surrounding this topic [9][10][11].

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Study of nystagmus suppression in the rotatory tests

1982

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Thirty one healthy subjects ranging in age between 21 and 50, participated voluntarily in the following experiment: they underwent programmed sequential alternating rotations, while their nystagmus was recorded by way of electronystagmography. The direction of rotation was changed every minute, and the total rotation time was 36 minutes. The subjects were rotated under external conditions which were altered every six minutes; these conditions included the following: 1. Rotation in the light with visual fixation and convergence. 2. Rotation in the light with visual fixation without convergence (one eye closed, the other looking at the target). 3. Rotation in the light without visual fixation (both eyes covered by a shade or by Frenzel's glasses). 4. Rotation in the dark without convergence (looking straight ahead). 5. Rotation in the dark with convergence (looking at the thumb, closely placed in front of the nose). The purpose of the experiment was to study the phenomenon of nystagmus suppression observed with visual fixation and often attributed to cortical activity. The conclusion of the study is that nystagmus may be suppressed by light alone as well as by visual stimuli, convergence and proprioceptive stimuli. The inference is that the mechanism involves brain stem reflexes and not necessarily visual cortex activity.

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Galvanic vestibular tests in the assessment of coma and brain death

Cited by 5 publications

References 2 publications

Using video-oculography for galvanic evoked vestibulo-ocular monitoring in comatose patients

Using video-oculography for galvanic evoked vestibulo-ocular monitoring in comatose patients

Analytic Reviews : The Diagnosis of Brain Death in the Adult Patient

Study of nystagmus suppression in the rotatory tests

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