Brain herniation and eye movement

  1. 0
    I have been trying to look up the name of this eye movement, but have not had any luck. Any of you that have experience with this, please chime in.

    Pt had massive global stroke, younger 50ish. I was reading the notes before I got this transfer and it stated that there was no herniation as of yet, but without surgery the MD's thought that it was likely that the brain would herniate.

    When I recieved the pt, her eyes were moving like you were reading a book. It didn't matter if you opened her eye lids or if the lids were closed, her eyes were still moving back and forth like reading a book. I know this is a sign of brain damage, but would like to know the technical term for it if anyone knows what I am talking about.

    Thanks!
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  5. 0
    I had one of those and charted, "REM noted to L and R sides, continuous, not associated with sleep."
  6. 0
    Everything that I am looking up mentions nystamus or abscent upward movement of the eye, but nothing that really describes what I was seeing.

    Nerdtonurse, what was the diagnosis with your pt?
  7. 0
    it is called dolls eye reflex
  8. 1
    actually her head was perfectly stationary. I thought that doll's eye reflex was only when you turned the pt's head and their eyes still looked forward rather than the normal responce which is to turn the eyes to the opposite side of the way the head is turned.

    I think that I found my answer. From what I was reading it is Ping Pong gaze and when it stops is when the herniation reaches the brain stem and the pts die soon afterward.
    tewdles likes this.
  9. 0
    Quote from TonyaM73
    actually her head was perfectly stationary. I thought that doll's eye reflex was only when you turned the pt's head and their eyes still looked forward rather than the normal responce which is to turn the eyes to the opposite side of the way the head is turned.

    I think that I found my answer. From what I was reading it is Ping Pong gaze and when it stops is when the herniation reaches the brain stem and the pts die soon afterward.
    oh, sorry..i thought you were turning her head..misread post.

    i'm very very tired, just trying to stay awake so i dont wake up at 4am again. almost 8pm..another hour i can go to bed and do me owm rem


    a patient i looked after who herniated on me had some brain tissue come through her nose. her face was so tight from swelling, i can still picture it like it was yersteday and not 18 years ago
  10. 4
    It's called Nystagmus.
    turnforthenurseRN, ohcomeon, tewdles, and 1 other like this.
  11. 0
    sorry, forgot to put the "g" in nystagmus in the other post. Not enough coffee yet.
  12. 0
    What's the difference between nystagmus and a ping pong gaze?
  13. 12
    there are different kind of nystagmus depending on influence whether alcohol, injury, tumor, bleed or virus.
    • peripheral nystagmus occurs as a result of either normal or diseased functional states of the vestibular system and may combine a rotational component with vertical or horizontal eye movements and may be spontaneous, positional, or evoked.
    • positional nystagmus occurs when a person's head is in a specific position. an example of disease state in which this occurs is benign paroxysmal positional vertigo (bppv).
    • gaze induced nystagmus occurs or is exacerbated as a result of changing one's gaze toward or away from a particular side which has an affected vestibular apparatus.
    • post rotational nystagmus occurs after an imbalance is created between a normal side and a diseased side by stimulation of the vestibular system by rapid shaking or rotation of the head.
    • spontaneous nystagmus is nystagmus that occurs randomly, regardless of the position of the patient's head.
    • central nystagmus occurs as a result of either normal or abnormal processes not related to the vestibular organ. for example, lesions of the midbrain or cerebellum can result in up- and down-beat nystagmus.
    opsoclonus refers to uncontrolled eye movement. opsoclonus consists of rapid, involuntary, multifactorial (horizontal and vertical), unpredictable, conjugate fast eye movements without inner saccadic intervals. it is also referred to as saccadomania or reflexive saccade. the movements of opsoclonus may have a very small amplitude, appearing as tiny deviations from primary position.


    possible etiologies of opsoclonus include neuroblastoma and encephalitis in children, and breast, lung, or ovarian cancer in adults. other considerations include multiple sclerosis, toxins, or medication effects. it can also be caused by a lesion in the omnipause neurons which tonically inhibit initiation of saccadic eye movement (until signaled by the superior colliculus) by blocking paramedian pontine reticular formation (pprf) burst neurons in the midbrain. it frequently occurs along with myoclonus in opsoclonus myoclonus syndrome.

    nystagmus is very noticeable but little recognized. nystagmus can be clinically investigated by using a number of non-invasive standard tests. the simplest one is caloric reflex test, in which one external auditory meatus is irrigated with warm or cold water or air. the temperature gradient provokes the stimulation of the horizontal semicircular canal and the consequent nystagmus.

    doll's eye reflex is more correctly called the oculocephalic reflex. it is where rotation/flexion of the of the head cause transient eye movement in the opposite direction (lindsay, bone and calendar 1997 neurology and neurosurgery illustrated p30)


    doll's eye reflex is only seen on unconscious patients and it only shows brain stem functioning so depending on the patient it can be a good sign - not good when it is the only sign still intact.
    http://en.wikipedia.org/wiki/vestibulo-ocular_reflex

    ping pong gaze

    examination disclosed periodic eye movements with an initial downward deviation followed by rapid upward correction (dipping), which lasted 10 to 15 seconds (figure, a; video e-1, on the neurology web site at www.neurology.org). intermittently, these movements were followed by slow to-and-fro horizontal eye motion (ping-pong gaze) immediately or with a latency of several seconds

    http://www.neurology.org/content/68/3/222.full

    i hope this helps....:0


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