Examination Of The Unconscious Patient

Eye movements

Observe any spontaneous eye movements.

Elicit the oculocephalic (doll's eye) reflex.

Rotation or flexion/extension of the head in a comatose patient produces transient eye movements in a direction opposite to that of the movement.

(Eyes held open by examiner)

(Eyes held open by examiner)

Note whether the movements, if present, are conjugate (i.e. the eyes move in parallel) or dysconjugate (i.e. the eyes do not move in parallel). These ocular movements assess midbrain and pontine function.

Elicit the oculovestibular reflex (caloric testing, see page 62).

Visual fields

In the unco-operative patient, the examiner may detect a hemianopic field defect when 'menacing' from one side fails to produce a 'blink'.

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