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Thus, the absence of doll's eyes suggests brainstem dysfunction in the comatose patient but can be normal in the awake patient. Another, more potent stimulus of the vestibulo-ocular reflex used to evaluate comatose patients is caloric stimulation see Neuroanatomy Through Clinical Cases , Chapter 3. Careful testing can often identify abnormalities in individual muscles or in particular cranial nerves oculomotor, trochlear, or abducens in their course from the brainstem to the orbit, in the brainstem nuclei, or finally, in the higher-order centers and pathways in the cortex and brainstem that control eye movements for more details, see Neuroanatomy Through Clinical Cases , Chapter Spontaneous nystagmus can indicate toxic or metabolic conditions such as drug overdose or alcohol intoxication, or peripheral or central vestibular dysfunction.

Smooth Pursuit Your browser does not support h. Your browser does not support h. If the gain of the VOR is wrong different from 1 —for example, if eye muscles are weak, or if a person puts on a new pair of eyeglasses—then head movement results in image motion on the retina, resulting in blurred vision.

Under such conditions, motor learning adjusts the gain of the VOR to produce more accurate eye motion.

Extraocular Movements (CN III, IV, VI)

This is what is referred to as VOR adaptation. Ethanol consumption can disrupt the VOR, reducing dynamic visual acuity. This reflex can be tested by the rapid head impulse test or Halmagyi—Curthoys test , in which the head is rapidly moved to the side with force, and is controlled if the eyes succeed to remain to look in the same direction. When the function of the right balance system is reduced, by a disease or by an accident, a quick head movement to the right cannot be sensed properly anymore.

Doll's Eyes and Brainstem Stroke - Resus

As a consequence, no compensatory eye movement is generated, and the patient cannot fixate a point in space during this rapid head movement. Another way of testing the VOR response is a caloric reflex test , which is an attempt to induce nystagmus compensatory eye movement in the absence of head motion by pouring cold or warm water into the ear.

Normal and Abnormal Eye Movements

Also available is bi-thermal air caloric irrigations, in which warm and cool air is administered into the ear. In comatose patients, once it has been determined that the cervical spine is intact, a test of the vestibular-ocular reflex can be performed by turning the head to one side. If the brainstem is intact, the eyes will move conjugately away from the direction of turning as if still looking at the examiner rather than fixed straight ahead.

Negative "doll's eyes" would stay fixed midorbit, and having negative "doll's eyes" is therefore a sign that a comatose patient's brainstem is functionally not intact. Currently, vestibulo-ocular reflexes can only be comprehensively tested in specially equipped laboratories.

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The tests sometimes provide valuable diagnostic information; however, the tests can be time-consuming and expensive to administer [ citation needed ]. The scleral search coil can be used to assess the vestibulo-ocular reflex. The vestibulo-ocular reflex is tested by the caloric test. No eye movements are seen during or following the slow injection of at least 50 ml of ice-cold water over 60 s into each external auditory meatus in turn. Testing of the reflex forms part of the confirmation of a diagnosis of brainstem death.


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Diagnosing brainstem death requires a certain code of practice, written by the Academy of Medical Royal Colleges. The cerebellum is essential for motor learning to correct the VOR in order to ensure accurate eye movement.

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Motor learning in the VOR is in many ways analogous to classical eyeblink conditioning , since the circuits are homologous and the molecular mechanisms are similar. Neck injuries , degenerations or pain are contraindication. Test that involves rapid head rotation could occasionally injure the neck or the vertebral arteries. From Wikipedia, the free encyclopedia. This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources.


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Unsourced material may be challenged and removed. White baneberry, also called doll's eyes, makes a beautiful addition to the native plant garden, with attractive foliage and long-lasting cluster of white fruits. The fruits are toxic to humans. The Blackfoot used a decoction of the roots as a remedy for colds and coughs. There is a red-fruited form formerly called Actaea pachypoda forma rubrocarpa that is generally rare but may be frequent in some locations.

Occurs only in non-wetlands. Exact status definitions can vary from state to state. For details, please check with your state. Actaea alba , auct. Red-fruited plants forma rubrocarpa , though generally rare, can be locally frequent. The hybrids are variable and show different combinations of character states e.