Caloric Stimulation in Localization of Brain-Stem Lesions in a Comatose Patient

CALORIC stimulation, employing cold water, in the comatose patient results in conjugate tonic deviation of the eyes toward the side stimulated, provided that the vestibulo-ocular brain-stem pathways are intact.¹The absence of cerebral influence had been held responsible for both the loss of nystagmus and the antagonism to the vestibular impulses. Hence, tonic deviation occurs. If, in addition, the vestibulo-ocular pathway is interrupted in the posterior longitudinal bundle, a fairly definite sequence of events should follow caloric stimulation. The following case report illustrates this predictable sequence. REPORT OF A CASE Clinical Abstract.— T. L., a white man aged 47, was admitted to the neurological service of Mount Sinai Hospital on March 31, 1951, because of sudden onset of stupor. He had complained of bifrontal headache and nausea for 24 hours prior to admission. Several hours before admission he suddenly lapsed into stupor. He had not been hypertensive or diabetic.