Vestibulo-ocular reflex as predictor of cerebral death in comatose patients.

OBJECTIVE Our goal was to establish the role of VOR - vestibular ocular reflex - in predicting cerebral death in comatose patients. PATIENTS AND METHODS Prognosis study based on three concurrent cohorts of comatose patients of known etiology followed until the ultimate outcomes: recovery, vegetative state or death. Sixty comatose patients (Glasgow scale 8 or less) with known causes were studied: 49 males and 11 females; 7 to 83 years old. The cold water vestibular stimulation was performed at the bedside by irrigation with 0o Celsius saline in the external auditory canal during one minute. The reflex was considered present when both eyes deviated toward the stimulated side (19 patients group 1); present but abnormal for irregular unconjugated eye movements (11 patients group 2) or absent (30 patients, group 3). RESULTS Group 1 had total recovery in 42%, partial recovery in 37% and cerebral death in 21%. These results were 9%, 18% and 73% for group 2, respectively and group 3 had 100% cerebral death. The difference was statistically significant between groups 1 and 2, 3 (p<0,05 Fischer exact test and X2 test). CONCLUSION Absence of VOR predicted 100% of cerebral death and VOR present normal predicted 21% of cerebral death in the comatose patients we studied.