A change in only one pupil indicates lateralizing pressure and requires immediate notification of the physician. The conscious patient is asked to follow a light or object through the six cardinal fields. Abnormal oculocephalic reflex indicates some degree of brainstem injury. The oculocephalic test is performed only after the possibility of cervical injury is ruled out. The patients head is rapidly turned to each side.
Normal response is for the eyes to move with the head.
A positive doll's eyes, an abnormal response, occurs when the eyes constantly look upward, regardless of which way the head is turned. For example, the right side may exhibit decorticate posturing and the left side may be flaccid. Vital signs Vital signs changes are very late neurological indicators. Changes in respiratory pattern and rate, heart rate and blood pressure indicate pressure on the vital centers in the brainstem. Respiratory patterns help identify the level of brainstem dysfunction.