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J Neurol Neurosurg Psychiatry 2008;79:223 doi:10.1136/jnnp.2007.121624
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Assessment of visual pursuit in post-comatose states: use a mirror

  1. A Vanhaudenhuyse1,
  2. C Schnakers1,
  3. S Brédart3,
  4. S Laureys1,2
  1. 1
    Coma Science Group and Cyclotron Research Centre, University of Liège, Belgium
  2. 2
    Department of Neurology, University of Liège, Belgium
  3. 3
    Department of Cognitive Science, University of Liège, Belgium
  1. Professor S Laureys, Coma Science Group, Cyclotron Research Centre, University of Liège, Sart Tilman B30, 4000 Liège, Belgium; steven.laureys{at}ulg.ac.be

    One of the first clinical signs differentiating the minimally conscious state (MCS) from the vegetative state is the presence of visual pursuit occurring in direct response to moving or salient stimuli.1 At present, there is no consensus on what visual stimulus should be employed at the patient’s bedside in the assessment of visual pursuit in post-comatose states. Indeed, several behavioural “coma scales” use different stimuli to evaluate visual pursuit: the Coma Recovery Scale-Revised (CRS-R) and Western Neuro-Sensory Stimulation Profile (WNSSP) employ a moving mirror; the Coma/Near Coma Scale, Wessex Head Injury Matrix (WHIM) and Sensory Modalities Assessment and Rehabilitation Technique (SMART) use a moving person; the WNSSP, SMART, WHIM and Full Outline of Unresponsiveness Scale use a moving object or finger (for references see review by Majerus and colleagues2).

    The aim of the present study was to determine whether the assessment of pursuit eye movements in MCS is influenced by the choice of the visual stimulus. Therefore, we prospectively studied visual pursuit using a standardised presentation of a moving mirror compared with a moving person and a moving object.

    METHODS

    MCS patients were studied free of sedative drugs in the acute (ie, within 4 weeks) and …

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