Glasgow Coma Scale

The Glasgow Coma Scale provides a score in the range 3-15; patients with scores of 3-8 are usually said to be in a coma. The total score is the sum of the scores in three categories. For adults the scores are as follows: Spontaneous--open with blinking at baseline Eye Opening Response Opens to pain, not applied to face None Oriented Confused conversation, but able to answer questions Verbal Response Incomprehensible speech None Obeys commands for movement Purposeful movement to painful stimulus Withdraws from pain Motor Response Abnormal (spastic) flexion, decorticate posture Extensor (rigid) response, decerebrate posture None For children under 5, the verbal response criteria are adjusted as follow SCORE 5 4 3 2 1 2 to 5 YRS Inappropriate words Grunts No response 0 TO 23 Mos. Cries and consolable Grunts or is agitated or restless No response 4 points

Opens to verbal command, speech, or shout 3 points 2 points 1 point 5 points 4 points

Inappropriate responses, words discernible 3 points 2 points 1 point 6 points 5 points 4 points 3 points 2 points 1 point

Appropriate words or phrases Smiles or coos appropriately Persistent cries and/or screams Persistent inappropriate crying &/or screaming

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July 30, 2001

Glasgow Coma scale (EMV Scoring) 1. Eye scoring I. Spontaneous- 4 II. to sound- 3 III. to pain- 2 IV. nil- 1 2. Motor movements I. Obey command- 6 II. Localizing pain- 5 III. Normal flexion- 4 IV. unnatural flexion- 3 V. extension- 2 VI. nil- 1 3. Verbal response I. Well oriented confined conversation- 5 II. inappropriate words- 4 III. incomprehensible sounds- 2 IV. none- 1

The scores progressively diminish as the comatoseness becomes deeper. Mechanism of Coma Coma may develop due to several mechanisms. About 60% of the total cases result from primary neurologic disease, while 40% result from systemic illnesses leading to metabolous disfunction of the brain. General mechanisms leading to comatoseness are: 1. Reduction in blood supply to the brain 2. lesions affecting the reticulate formation 3. electric disturbances as in seizure disorders 4. Disturbance in metabolism leading to dysfunction of cellular processes in the neurons; and 5. Psychiatric disturbances. Causes of Coma Neurological causes Ischemia to the brain and brain stem, eg, cerebrovascular accidents; stokes-Adams attacks, low cardiac output states, cerebral edema. Infections eg, meningitis and encephalitis. Rise in intracranial tension due to various causes; physical agents, eg, Cranio-cerebral injuries, hyperpyrexia, hypothermia, etc. Degenerative diseases, eg, Tay-Sachs disease, CruetzfeldtJakobs disease. Demyelination-postvaccinial, infective and allergic causes. Finally seizure disorders like grand mal, petit mal, temporal lobe seizures. Systemic diseases Metabolic causes-diabetic coma, uremia, hypoglycemia, acidosis, alkalosis, hyperosmolar states, respiratory failure, hepatic failure, and endocrine disorders such as hypothyroidism, Addisons disease and hypopituitarism. Also intoxication such as alcohol narcotics, and other poisons, cobra and krait bites could cause coma. Psychiatric disorders Though these ar not comatose states, their presentation may very closely resemble that of coma from which they have to be distinguished, eg, catatonic stupor, hysterical coma etc.