In normal awake subjects, doll's head responses are inconsistent and caloric stimulation produces nystagmus.
In light coma, cortical reflexes are lost, Doll's head reflexes can be demonstrated consistently, and caloric stimuli produces tonic lateral deviation rather than nystagmus. Severe vigorous turns of the head may be necessary to produce the doll's head responses.
With greater cortical depression, but still leaving the brainstem intact, both doll's head and caloric responses become very brisk.
Patients with metabolic cerebral depression generally retain reflex eye movements even when certain other signs of brainstem depression and central hyperventilation have already disappeared.
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