The vestibulo-ocular (caloric) reflex in the diagnosis of cerebral death

Correlation between vestibulo-ocular (caloric) reflex and the electroencephalogram was examined in 25 apparently brain-dead and 17 severely brain-injured patients. Among the apparently cerebrally dead, 3 patients still had some EEG activity and in 2, there was some response to caloric testing. In the control group of patients some EEG activity was present in all, and the caloric response was absent in 1. It is concluded that absence of caloric response has similar power to the electroencephalogram in confirming cerebral death. The diagnosis, however, must be made on the total information available, including history and examination of the patient. The policy of the Intensive Care Unit of Prince Henry Hospital in this regard is outlined.