Vestibulo-ocular monitoring as a predictor of outcome after severe traumatic brain injury

IntroductionBased on the knowledge that traumatic brainstem damage often leads to alteration in brainstem functions, including the vestibulo-ocular reflex (VOR), the present study is designed to determine whether prediction of outcome in the early phase after severe traumatic brain injury (sTBI) is possible by means of vestibulo-ocular monitoring (VOM).

Methods: VOM is based on video-oculographic (VOG) recording of eye movements during galvanic labyrinth polarization (GaLa). The integrity of VOR is determined from the eye movement response during vestibular GaLa stimulation.

VOM is performed within three days after TBI and the oculomotor response (OMR) compared to outcome after six months (Glasgow Outcome Score, (GOS)).

Results: Twenty-seven patients underwent VOM within three days after sTBI. One patient was excluded from the study.

In 16 patients OMR was induced, in the remaining 11 patients no OMR was observed. The patients'outcome was classified as GOS 1-2 or as GOS 3-5.

Statistical testing supported the hypothesis that those patients with OMR tended to recover (exact two-sided Fisher-Test (P<10-3)).

Conclusions: The results indicate that VOM with GaLa performed during the first days after TBI helps to predict favourable or unfavourable outcome. As an indicator of brainstem function, VOM provides a useful, complementary approach to the identification of brainstem lesions by imaging techniques.

Author: Hans-Georg SchlosserJan-Nikolaus LindemannPeter VajkoczyAndrew Clarke
Credits/Source: Critical Care 2009, 13:R192

Published on: 2009-11-30

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