doll’s-head maneuver
The doll's-head maneuver is a bedside test of the vestibulo-ocular reflex.1 The examiner rotates the patient's head, first horizontally and then vertically, while the patient fixates an object.1,2 A normal reflex turns the eyes in the direction opposite to the head, through an angle equal to the head movement.1,2 The stimulus comes from proprioceptive afferents in the neck, the vestibular system, or both.2 The response is also called the oculocephalic reflex or doll's head phenomenon.3
The maneuver separates supranuclear from infranuclear gaze palsies, because the reflex is maintained with a supranuclear lesion and lost with an infranuclear one.1 Limited eye movements that the maneuver overcomes are therefore likely supranuclear, and oculocephalic movements may be overly brisk in bilateral hemispheric disease.2 The maneuver can also expose a sixth nerve palsy, an internuclear ophthalmoplegia or a conjugate gaze paresis.2
In young children, the maneuver distinguishes a true paresis of the lateral rectus from a pseudoparesis.3 Oculocephalic maneuvers should not be performed in trauma patients with possible cervical spine injury.2
More detail
When oculocephalic movements are absent, ice-cold water applied against the tympanic membrane gives a stronger stimulus to the vestibulo-ocular reflex in the cold caloric test.2
In infants, the spinning baby test is the other common way to test the reflex.1 The practitioner holds the infant upright and rotates through 180 or 360 degrees, and the infant's eyes make a compensatory conjugate movement opposite to the rotation, then a fast movement back to primary position after about 30 degrees.1
Sources (7)
- Pickwell's Binocular Vision Anomalies, ch. 17
- Neuro-Ophthalmology: Diagnosis and Management, ch. 2
- von Noorden and Campos, Binocular Vision and Ocular Motility, ch. 4
- Rutstein, R., Daum, K. (1997). Anomalies of Binocular Vision: Diagnosis & Management, Mosby.
- Leigh, R. J., & Zee, D. S. (2015). The neurology of eye movements. Oxford University Press, USA.
- Baloh, R. W., & Honrubia, V. (2001). Clinical neurophysiology of the vestibular system. Oxford University Press, USA.
- Strupp, M., & Brandt, T. (2009). Vestibular neuritis. Seminars in neurology, 29(05), 509-519.
Reviewed October 2026