title: Abnormal downward gaze and cold caloric examination due to propofol: a case study.
abstract: BACKGROUND
  An adolescent girl had isolated abnormal downward gaze and oculovestibular (cold caloric) testing during propofol administration, prompting concern for brainstem abnormality.
  
  
  METHODS
  An otherwise healthy 16-year-old girl presented after an intentional hanging. Brainstem reflexes were normal except that both eyes exhibited tonic downward gaze on initial examination. After propofol was suspended for 30 minutes in order to evaluate her level of responsiveness, her eyes normalized to midposition from tonic downward gaze. With reinitiation of propofol, the eyes returned to the former downward position. C-collar stabilization prohibited the usual oculocephalic (doll's eyes) evaluation. Right-sided cold water instillation resulted in right eye exodeviation to the right with minimal medial movement of the left eye to the right. After left-sided cold water instillation, the left eye deviated downward with minimal medial deviation of the right eye. She was extubated and off sedatives within 48 hours of admission, and normal ocular motility returned.
  
  
  CONCLUSIONS
  This patient exhibited abnormal ocular motility and cold caloric response with single-agent propofol exposure. The remainder of her cranial nerve examination was normal, and her normal imaging studies and prompt resolution led us to suspect a propofol effect. Physicians should be aware of the pharmacologic alterations of ocular motility and cold caloric testing when propofol is administered.
authors.affiliation: Department of Child Neurology, Virginia Commonwealth University, Richmond, Virginia. Electronic address: TVu@mcvh-vcu.edu.
authors.forename: Thuy-Anh
authors.initials: TA
authors.lastname: Vu
authors.affiliation: Department of Pediatric Critical Care, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Alia
authors.initials: A
authors.lastname: O'Meara
authors.affiliation: Department of Child Neurology, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Jean
authors.initials: J
authors.lastname: Teasley
mesh_terms: D000293:Adolescent; D002150:Caloric Tests; D003080:Cold Temperature; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects* / Q000627:therapeutic use; D015835:Ocular Motility Disorders / Q000139:chemically induced*; D015742:Propofol / Q000009:adverse effects* / Q000627:therapeutic use; D013406:Suicide, Attempted
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol
keywords: caloric testing; eye movements; neurological examination; propofol