Monday, February 9, 2015

Study group discussion: Calorie test and true coma

How will you find out whether the prisoner is faking a coma or not?

Cold caloric oculovestibular reflex - A highly sensitive and specific test.

That's one of the test I had read used to pronounce the person brain dead. You push cold water in the person's ear, it stimulates a reflex. Rapid movement towards opposite side is normal.

Mnemonic is COWS.
Cold: Opposite side
Warm: Same side

So what will be the response in a patient with true coma?
True coma with an intact brain stem shows slow tonic deviation of the eye toward the ice!
EYES towards the ICE cold water.
And with damage to brainstem shows no response.
This reflex can't be faked.
So in awake patient fast phase nystagmus occurs away from the cold water!

Other uses of Calorie test:
One novel use of Calorie test has been to provide temporary pain relief from phantom limb pains in amputees and paraplegics. It can also induce a temporary remission of anosognosia, the visual and personal aspects of hemispatial  neglect, hemianesthesia, and other consequences of right hemispheric damage.
Anosognosia: When a person suffering a disease isn't self conscious of the disease (It's a deficit of self awareness.)


  1. amazing !!! for the curious minds, in india to declare brainstem death, two separate teams of neurologists conducts tests, 6 hours apart ! Only then can the person be declared as a brainstem dead case ! earlier in India the law on brainstem death declaration was termed as brain death ( cortical death), the 2011 amendment changed it to brainstem death for more clarity and specification.


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