simultaneous decerebrate and decorticate posteuring

Ridryder911 said:
I agree, erroneous information on the doll's eyes, as well I really doubt the posturing was alternating unless they went to progressive posturing as in ICP causing more damage. In regards to doll's eyes many perform the easy caloric test to detect brain stem function test.

R/r 911
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I'm getting confused about the absence of the doll's eye sign(An indicator of brain stem dysfunction, the absence of the doll's eye sign is detected by rapid, gentle turning of the patient's head from side to side. The eyes remain fixed in midposition, instead of the normal response of moving laterally toward the side opposite the direction the head is turned. I was reading a book that said the absence of this sign or reflex is generally found in decerebrate patients. After reading some of the posts here i re cheked on a few websites and got the same information.

Is the absence of the doll's eye sign derived more from the ICP than being decerebrately posteuring? I was hoping someone could clear me up on any misinformation i received or interpreted, and if i am completely wrong, what would be the signifigance of the absence of the doll's eye sign?
thanks
 
rescue99 said:
Could I suppose. There are lots of folks alert with the type of brain damage you describe. Some have doll looking eyes, some not.
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Guess I should have clarified reactive and non-reactive person.
 
Lifeguards For Life said:
I'm getting confused about the absence of the doll's eye sign(An indicator of brain stem dysfunction, the absence of the doll's eye sign is detected by rapid, gentle turning of the patient's head from side to side. The eyes remain fixed in midposition, instead of the normal response of moving laterally toward the side opposite the direction the head is turned. I was reading a book that said the absence of this sign or reflex is generally found in decerebrate patients. After reading some of the posts here i re cheked on a few websites and got the same information.

Is the absence of the doll's eye sign derived more from the ICP than being decerebrately posteuring? I was hoping someone could clear me up on any misinformation i received or interpreted, and if i am completely wrong, what would be the signifigance of the absence of the doll's eye sign?
thanks
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Whoops, sorry I said oculovestibular when I meant oculocephalic.

You describe the oculocephalic reflex correctly. It allows the gaze to remain on a fixed point. Reading would be nigh on impossible without this reflex allowing for the small involuntary movements of the head.

Absence of the oculocephalic reflex is known as Dolls Eyes where the position of the orbit remains fixed instead of moving when the head is moved.

It is a sign of absent brain stem activity, or bilateral pontine lesions. Bad stuff. I've only seen it a couple of times and it is creepy, not least because it essentially means the patient is braindead.

Oculovestibular sign is elicited by putting cold water in one ear (cold caloric test). A normal reflex is shown by slow movement of the eyes to the same side, followed by fast movement back (nystagmus). An absence of this demonstrates that the reticular activating system is broken (the sleep/wake switch). An unconscious patient will demonstrate a normal oculovestibular reflex but a comatose patient won't.

Clear as mud?

As the the posturing, can you describe exactly what was happening? I struggle to think of a good explanation for such a phenomon. The only thing that keeps coming to mind is pseudoseizures where unequal clonic activity is essentially diagnostic.
 
Smash said:
Whoops, sorry I said oculovestibular when I meant oculocephalic.

You describe the oculocephalic reflex correctly. It allows the gaze to remain on a fixed point. Reading would be nigh on impossible without this reflex allowing for the small involuntary movements of the head.

Absence of the oculocephalic reflex is known as Dolls Eyes where the position of the orbit remains fixed instead of moving when the head is moved.

It is a sign of absent brain stem activity, or bilateral pontine lesions. Bad stuff. I've only seen it a couple of times and it is creepy, not least because it essentially means the patient is braindead.

Oculovestibular sign is elicited by putting cold water in one ear (cold caloric test). A normal reflex is shown by slow movement of the eyes to the same side, followed by fast movement back (nystagmus). An absence of this demonstrates that the reticular activating system is broken (the sleep/wake switch). An unconscious patient will demonstrate a normal oculovestibular reflex but a comatose patient won't.

Clear as mud?

As the the posturing, can you describe exactly what was happening? I struggle to think of a good explanation for such a phenomon. The only thing that keeps coming to mind is pseudoseizures where unequal clonic activity is essentially diagnostic.
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I can think of one explanation....lantern skull. I'm sure there are others.
 
Smash, as always yor last paragraph occurred to me.

If you shoot in cold water and the pt screams, barfs and opens his eyes, or gets up and runs away....it's a MIRACLE!

Look at the whole picture,other signs and symptoms may indicate what's wrong while one obsesses over a particular one.

I am considering getting a "signature" that says "Cut to the chase".
 
Smash said:
Whoops, sorry I said oculovestibular when I meant oculocephalic.

You describe the oculocephalic reflex correctly. It allows the gaze to remain on a fixed point. Reading would be nigh on impossible without this reflex allowing for the small involuntary movements of the head.

Absence of the oculocephalic reflex is known as Dolls Eyes where the position of the orbit remains fixed instead of moving when the head is moved.

It is a sign of absent brain stem activity, or bilateral pontine lesions. Bad stuff. I've only seen it a couple of times and it is creepy, not least because it essentially means the patient is braindead.

Oculovestibular sign is elicited by putting cold water in one ear (cold caloric test). A normal reflex is shown by slow movement of the eyes to the same side, followed by fast movement back (nystagmus). An absence of this demonstrates that the reticular activating system is broken (the sleep/wake switch). An unconscious patient will demonstrate a normal oculovestibular reflex but a comatose patient won't.

Clear as mud?

As the the posturing, can you describe exactly what was happening? I struggle to think of a good explanation for such a phenomon. The only thing that keeps coming to mind is pseudoseizures where unequal clonic activity is essentially diagnostic.
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Yeah, clear as mud, thank you for the clarification. I talked to my Anatomy teacher, who said that an absence of the doll's eye sign or reflex is more indicative of the increased ICP, not necessarily either of the earlier mentioned postures. Neither alternating(periods of displaying decerebrate posturing interrupted by periods of decoritate posturing) nor simultaneously displaying decerebrate and decorticate posturing(for instance being decerebrate on the left side of your body, at the same time being decorticate on the right side) offers a better prognosis, the are supposedly equally bad.
Put as simply as i can, if the patient is alternating between the two, it may be as simple as fluctuations in neuro status, i do not remember her full explanation exactly, nor do i remember the reason that the patient would display both as opposed to alternating between the two. Does that clear up my original question?
I believe it was a confusing question, probably poorly worded on my part, though she was able to provide an in depth explanation,
 
Intracranial swelling is non-discriminatory...I meant indiscriminate.

I guess in theory various structures in the brain are affected in some sort of sequence by progressive increases in ICP and demonstrated by a sequenced series of changing signs, but basically they are all being squished in the same closed vessel (your head, unless it has been opened) and can progress rapidly enough that they are, for field/stream/street EMS, mostly academic.
In-house and fer emergency admit, probably much more important and apparent.
 
Lantern skull? Aside from the ones I carve out of pumpkins every year, I've not heard of that.
 
Lifeguards For Life said:
yes, and several google search's have only shown halloween pumpkins. Could you explain rescue?
thought theese pumpkins were humerous though...
http://www.shipmentoffail.com/wp-content/uploads/2009/09/puking-pumpkins-win.jpg
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Transillumination of the skull. A notable finding when significant hydranencephaly is present in neonates to maybe 12ish years old, when the skull is thinner. A light or direct light held to the skull shows a glow where fluid is present. Similar looking to what happens when you hold a light to your hand. I've seen it and hope to never see it again.
 
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An example was pointed out to me yesterday

Mulitple small but potent insults such as bleeds can cause exhibition of both decerebrate and decorticate signs.
 
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