What are findings of the oculocephalic reflex suggestive of acquired nystagmus?

Updated: Oct 17, 2018
  • Author: Christopher M Bardorf, MD, MS; Chief Editor: Edsel Ing, MD, MPH, FRCSC  more...
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Answer

Oculocephalic reflex (doll's head phenomenon)

  • The oculocephalic reflex develops within the first week of life and essentially represents a vestibulo-ocular reflex normally suppressed in a conscious individual that attempts to turn the head to fixate on an object.

  • This test consists of the rapid rotation of the patient's head in a horizontal or vertical direction. With intact vestibular nuclei and medial longitudinal fasciculi, the eyes move conjugately in the opposite direction of the head turn. Alternatively, the test may be performed by having the patient extend the arm out in front of the body and fixate on the outstretched thumb. Patients should be instructed to rotate their torso back and forth about their longitudinal axis such that the thumb remains in front of the body at all times.

  • Patients with the ability to suppress the oculocephalic reflex should be able to maintain fixation on their thumb while rotating. An abnormal test result would show the patient continuously losing fixation of the thumb.

  • Inability to suppress the oculocephalic reflex is common in patients with vestibular imbalance.


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