STUDY - Technical - New Dacian's Medicine
Doll's
eye sign, absent (Classical / Allopathic Medicine)
An indicator of
brain stem dysfunction, the absence of the doll's eye sign is
detected by rapid, gentle turning of the patient's head from
side to side. The eyes remain fixed in mid-position, instead
of moving laterally toward the side opposite where the head is
turned. (See Testing for absent doll's eye sign.)
The absence of the
doll's eye sign, also known as the negative oculocephalic
reflex, indicates injury to the midbrain or pons, involving
cranial nerves III, VI, and VIII. It typically accompanies
coma caused by lesions of the cerebellum and brain stem. This
sign usually can't be relied upon in a conscious patient
because he can control eye movements voluntarily. An absent
doll's eye sign is necessary for a diagnosis of brain death.
A variant of an
absent doll's eye sign that develops gradually is known as an
abnormal doll's eye sign: Because conjugate eye movement is
lost, one eye may move laterally and the other remains fixed
or move in the opposite direction. An abnormal doll's eye sign
usually accompanies metabolic coma or increased intracranial
pressure (ICP). Associated brain stem dysfunction may be
reversible or progress to a deeper coma with an absent doll's
eye sign.
PHYSICAL
ASSESSMENT:
Evaluate the patient's level of consciousness, using the Glasgow Coma Scale.
Note decerebrate or decorticate posture.
Examine the pupils for size, equality, and response to light.
Check for signs of increased ICP - increased blood pressure, increased pulse pressure, and bradycardia.
Evaluate the patient's level of consciousness, using the Glasgow Coma Scale.
Note decerebrate or decorticate posture.
Examine the pupils for size, equality, and response to light.
Check for signs of increased ICP - increased blood pressure, increased pulse pressure, and bradycardia.
Testing for absent
doll's eye sign
To evaluate the patient's oculocephalic reflex, hold her upper eyelids open and quickly (but gently) turn her head from side to side, noting eye movements with each head turn.
With an absent doll's eye sign, the eyes remain fixed in mid-position.
SPECIAL CONSIDERATIONS:
Don't attempt to elicit a doll's eye sign in a comatose patient with suspected cervical spine injury; doing so risks spinal cord damage. Instead, evaluate the oculovestibular reflex with the cold caloric test. Normally, instilling cold water in the ear causes the eyes to move slowly toward the irrigated ear. Cold caloric testing may also be done to confirm an absent doll's eye sign.
To evaluate the patient's oculocephalic reflex, hold her upper eyelids open and quickly (but gently) turn her head from side to side, noting eye movements with each head turn.
With an absent doll's eye sign, the eyes remain fixed in mid-position.
SPECIAL CONSIDERATIONS:
Don't attempt to elicit a doll's eye sign in a comatose patient with suspected cervical spine injury; doing so risks spinal cord damage. Instead, evaluate the oculovestibular reflex with the cold caloric test. Normally, instilling cold water in the ear causes the eyes to move slowly toward the irrigated ear. Cold caloric testing may also be done to confirm an absent doll's eye sign.
PEDIATRIC
POINTERS:
Normally, the doll's eye sign isn't present for the first 10 days after birth and may be irregular until age 2. After that, this sign reliably indicates brain stem function.
An absent doll's eye sign in a child may accompany a coma associated with a head injury, near drowning or suffocation, or brain stem astrocytoma.
Normally, the doll's eye sign isn't present for the first 10 days after birth and may be irregular until age 2. After that, this sign reliably indicates brain stem function.
An absent doll's eye sign in a child may accompany a coma associated with a head injury, near drowning or suffocation, or brain stem astrocytoma.
PATIENT
COUNSELING:
An absent doll's eye sign is an ominous sign for the comatose patient. Support the family and provide information regarding the patient's outcome whenever possible.
An absent doll's eye sign is an ominous sign for the comatose patient. Support the family and provide information regarding the patient's outcome whenever possible.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)