Buettner U W
Department of Neurology, Eberhard-Karls University, Tübingen, Germany.
Baillieres Clin Neurol. 1992 Aug;1(2):289-300.
Ocular motor disorders in stupor and coma are important clinical signs which are easily accessible with observation and a few bedside manoeuvres. Although the manifold signs of ocular motor dysfunction may be confusing to most clinicians, many of the signs can be attributed to clear pathophysiological mechanisms. This holds for conjugate eye deviations as well as for most spontaneous eye movements in coma. Using simple methods to elicit reflex eye movements, in most cases a lesion site within or outside the brain stem can be determined. It is stressed that an exact description and documentation of the ocular motor deficit is necessary. The following key aspects should be included in such a documentation: pupil size and reaction, conjugate or disconjugate eye position, spontaneous eye movements and VOR elicited either by head rotation or caloric irrigation. The latter allows assessment of the ocular motor integrator. The VOR may be intact, indicated by full compensatory eye movements, but the gaze-holding mechanism (integrator) can be defective, thus permitting the eyes to drift back to the primary position.
昏迷和木僵状态下的眼球运动障碍是重要的临床体征，通过观察和一些床边操作即可轻易获取。尽管眼球运动功能障碍的多种体征可能会让大多数临床医生感到困惑，但许多体征都可归因于明确的病理生理机制。这适用于共轭性眼球偏斜以及昏迷中的大多数自发性眼球运动。使用简单方法引出反射性眼球运动，在大多数情况下可以确定脑干内或脑干外的病变部位。需要强调的是，对眼球运动缺陷进行准确描述和记录是必要的。此类记录应包括以下关键方面：瞳孔大小及反应、共轭或非共轭眼球位置、自发性眼球运动以及通过头部旋转或冷热试验引出的前庭眼反射（VOR）。后者可用于评估眼球运动整合器。VOR可能是完整的，表现为眼球完全补偿性运动，但凝视保持机制（整合器）可能存在缺陷，从而使眼球漂移回初始位置。
