Prognostic value of the caloric-vestibular test in the unconscious patient with cranial trauma.

Abstract

100 unconscious patients with traumatic brain injury were subjected to caloric-vestibular stimulation using 30° C water. The following reactions were observed: Group 1 (30 patients): Rapid and slow phase of nystagmus. Group 2 (30 patients): Conjugate horizontal ocular deviation. Group 1 (30 patients): Internuclear paresis. Group 4 (22 patients): Abolished caloric-vestibular response. When the test was carried out 1–3 days after the head injury, a single test proved of prognostic value. At follow-up at least one year later: (1) all patients of group 4 had died, (2) no patient of group 1 or 2 had died, (3) no patient of group 1 was helpless, (4) no patient of group 3 could go back to work and more than half the patients of this group had died. One year after the head injury neurological signs were found with increasing frequency and severity from group 1 to group 3. There was no definite relationship between the vestibulo-ocular reflex pattern and the duration of the unconsciousness.