Monday, February 29, 2016

Q: Which test can rule out Psychogenic coma or Malingering?

Answer: Cold caloric test

Cold caloric test (oculovestibular reflex) can rule out psychogenic coma or malingering with very high sensitivity and specificity. Irrigation of ear with 60-100mL of ice water can have 3 kinds of response

  • A slow tonic deviation of the eye toward the ice happens in true coma with an intact brainstem. 
  • No response means damage to the brainstem 
  • Fast phase nystagmus away from the cold ear happens in an awake patient.

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