Using video-oculography for galvanic evoked vestibulo-ocular monitoring in comatose patients.

Binocular eye movement responses to galvanic vestibular stimulation were measured in comatose patients. Healthy persons have been demonstrated to show a consistent and reproducible relationship between eye movement and galvanic vestibular stimulation. Any pathology of the vestibular integrating structures (brainstem and to some degree the cerebellum and cortex) is assumed to influence this response pathognomonically. A monitoring facility was designed to record eye movements during galvanic labyrinth polarization (GaLa) in order to examine the vestibular response in comatose patients. GaLa was applied by means of two pairs of electrodes attached between the mastoid and interscapular region. A custom-built, battery-driven current-source stimulator served to generate sinusoidal stimuli that could be applied either unilaterally or simultaneously and independently to the left and right labyrinths. The resultant binocular eye movements were recorded using a Chronos Eye Tracker and the digital image sequences stored for subsequent analysis. Repeated testing was performed in five comatose patients with a Glasgow Coma Score of 3, who were intubated and ventilated (subarachnoid hemorrhage (n = 3), traumatic injury (n = 2)). The observed ocular movements varied. In four cases ocular movements in response to GaLa were observed, while one patient showed neither spontaneous nor galvanic-induced eye movements. The latter was diagnosed as brain-dead 2 days after testing. In contrast, the patients who showed ocular movements synchronous with galvanic stimulation left the intensive care unit (ICU) for rehabilitation. These data indicate that it is possible to assess brain function in comatose patients by evaluating the vestibulo-ocular response to galvanic stimulation. The designed monitoring facility can be used on the ICU ward without disconnection of other monitoring equipment.