Doll's head maneuver

Doll's Head Maneuver (also known as the oculocephalic reflex) is a clinical test used in neurology to assess the integrity of the brainstem, specifically the vestibulo-ocular reflex (VOR). This reflex is crucial for maintaining stable vision during head movements. The Doll's Head Maneuver is typically performed in patients who are unconscious or who have severe neurological impairments.

Procedure

The Doll's Head Maneuver is conducted by holding the patient's eyelids open and quickly rotating the head from side to side or up and down. In a normal response, the eyes will move in the opposite direction of the head movement. This is due to the activation of the vestibulo-ocular reflex, which allows the eyes to remain focused on a fixed point in space despite movements of the head. If the eyes do not move in the opposite direction, it suggests a lesion in the brainstem or damage to the cranial nerves involved in eye movement (specifically, the oculomotor nerve, trochlear nerve, and abducens nerve).

Indications

The Doll's Head Maneuver is indicated in cases where there is suspicion of brainstem damage. It is particularly useful in the evaluation of patients with severe head injuries, coma, or other conditions that impair consciousness and voluntary eye movement. It helps in distinguishing between supratentorial and infratentorial lesions and in assessing the function of the vestibulo-ocular reflex pathway.

Contraindications

The maneuver should not be performed if there is any suspicion of a cervical spine injury, as moving the head could exacerbate the injury. Additionally, caution should be exercised in patients with neck pain or a history of cervical spine problems.

Interpretation

A positive Doll's Head Maneuver (normal reflex) indicates that the brainstem is functioning and that the lack of eye movement is likely due to a supratentorial lesion or a non-neurological cause. A negative result (abnormal reflex) suggests a dysfunction in the brainstem or damage to the cranial nerves responsible for eye movement.

Clinical Significance

The Doll's Head Maneuver is a valuable tool in the neurological assessment of unconscious patients. It provides immediate information about the functional status of the brainstem and can guide further diagnostic and therapeutic decisions. However, it is important to note that this test is only one component of a comprehensive neurological examination and should be interpreted in the context of other clinical findings.