Victor
45, Male
A general inspection revealed that:
- Victor was in pain, tired and distressed.
- He was pyrexial with a temperature of 38°C and had a subtle speech disturbance with some dysphasia, in particular difficulty finding words. Victor was oriented in place but did not know the time, date or who the Prime Minister was.
- The GP noticed some eyelid twitching but could not find anything else on neurological examination.
- Pulse 65 beats/min and BP 120/85. There was no papilloedema on examining the back of the eyes.
The GP referred Victor immediately to the local hospital Emergency Department.
On arrival, he had become more confused and a Glasgow Coma Scale (GCS) score was carried out which was 12.
Question: What does the Glasgow Coma Scale measure? (Click to reveal)
Answer:
The GCS is a way of assessing the level of consciousness of patients with an acute brain injury. See http://www.glasgowcomascale.org/what-is-gcs/#development.
The GCS measures the following functions:
Eye Opening (E)
- 4 = spontaneous
- 3 = to voice
- 2= to pain
- 1 = none
Verbal Response (V)
- 5 = normal conversation
- 4 = disoriented conversation
- 3 = words, but not coherent
- 2= no words, only sounds
- 1 = none
Motor Response (V)
- 6 = normal
- 5 = localized to pain
- 4 = withdraws to pain
- 3 = decorticate posture
- 2= decerebrate posture
- 1 = none
Using this scale, brain injury is classified as:
- Severe: GCS 3-8
- Moderate: GCS 9-12
- Mild: GCS 13-15
Moderate and severe brain injuries often result in long-term impairments in any of the following : cognition, physical skills, emotional/behavioural issues.