Glasgow Coma Scale

Category Score 4 3 2 1 5 4 3 2 1 6 5 4 3 2 1 Response Spontaneous-eye open spontaneously without stimulation To speech-eye open with verbal stimulation but not necessarily to command To pain-eye open with noxious stimuli None - no eye opening regardless of stimulation Oriented - accurate information about person, place, time, reason for hospitalization and personal data. Confused-answers not appropriate to question, but use of language is correct Inappropriate words-disorganized, random speech, no sustained conversation Incomprehensible sounds-moans, groans, and incomprehensible mumbles None-no verbalization despite stimulation Obeys commands-performs simple tasks on command; able to repeat performance Localized to pain-organised attempt to localize and remove painful stimuli Withdraws from pain- withdrawn extremity from source of painful stimuli Abnormal flexion- decorticate posturing spontaneously or in response to noxious stimuli Extension- decerebrate posturing spontaneously or in response to noxious stimuli None- no response to noxious stimuli; flaccid

Eye opening

Verbal response

Best motor response

Classification of abnormal Motor function:Spontaneous occurs without regard to external stimuli and may not occur by request Localization Occurs when the extremities opposite the extremity receiving pain crosses midline of the body in an attempt to remove the noxious stimulus from the affected limb Withdrawal Occurs when the extremity receiving the painful stimulus flexes normally in an attempt to avoid the noxious stimulus Decortication Abnormal flexion response that may occur spontaneously or in response to noxious stimuli.( In response to painful stimuli, the upper extremities exhibit flexion of the arm, wrist, and fingers with adduction of the limb. The lower extremity exhibits extension, internal rotation, and planter flexion. Abnormal flexion occurs with lesions above the midbrain, in the region of the thalamus or cerebral hemispheres.) Decerebration Abnormal extension response that may occur spontaneously or in response to noxious stimuli (when the patient is stimulated, teeth clench and the arms are stiffly extended, adducted, and hyperpronated. The legs are stiffly extended with plantar flexion of the feet. Abnormal extension occurs with lesions in the area of the brainstem. Because abnormal flexion and extension

appears similar in the lower extremities, the upper extremities are used to determine the presence of these abnormal movements.) Flaccid- No response to painful stimuli

Categorises of consciousness:Alert patient response immediately to minimal external stimuli Confused patient is disoriented to time or place but usually oriented to person, with inpaired judgement and decision making and decreased attention span. Delirious patient is disoriented to time, place, and person with loss of contact with reality and often has auditory or visual hallucinations. Lethargic patient displays a state of drowsiness or inaction in which the patient needs an increased stimulus to be awakened. Obtunded patient displays dull indifference to external stimuli, and response in minimally maintained. Questions are answered with a minimal response. Stuporous patient can be aroused only by vigorous and continuous external stimuli. Motor response is often withdrawal or localizing to stimulus. Comatose vigorous stimulation fails to produce any voluntary neural response.