Neuro/cognition

• Arms FLEXED toward chest

• Wrists flexed, fingers curled

• Legs extended and internally rotated

• Indicates damage to cortical areas

• Less severe than decerebrate

Decorticate (flexion) — GCS motor 3

• Arms EXTENDED and rigid

• Forearms pronated

• Legs extended

• Indicates brain stem damage

• MORE SEVERE — worse prognosis

Decerebrate (extension) — GCS motor 2

Neurological causes

• Stroke

• Brain injury (TBI, bleed)

• Infection (meningitis, encephalitis)

• Seizures

• Increased ICP

Systemic/metabolic causes

• Hypoxia

• Hypoglycemia

• Electrolyte imbalances

• Sepsis

• Opioids, sedatives, alcohol

• Fever

Full consciousness → decreased concentration/agitation/confusion → requires repeated stimulation to arouse → reflexive posturing to pain → no response → coma

Progression of deteriorating brain function

Smell (S)

Identify odors with each nostril (eyes closed)

Olfactory

Vision (S)

Snellen/Rosenbaum; visual fields

Optic

Eye movement, pupil constriction (M)

PERRLA; accommodation (near/far gaze)

Oculomotor

Eye movement downward/inward (M)

Follow penlight through 6 cardinal fields

Trochlear

Facial sensation, chewing (M/S)

Corneal blink reflex; light/sharp/dull sensation on face; hot/cold discrimination

Trigeminal

Lateral eye movement (M)

Follow penlight laterally; conjugate gaze

Abducens

Facial expression, taste anterior 2/3 tongue (M/S)

Smile, raise eyebrows, frown, puff cheeks, close eyes tightly; identify tastes

Facial

Hearing, balance (S)

Ticking watch at 2–3 cm; Weber/Rinne tests; gait assessment

Vestibulocochlear

aste posterior tongue, swallowing (M/S)

Gag reflex; say "ah" — uvula rises midline

Glossopharyngeal

Swallowing, speech, visceral functions (M)

Swallow without difficulty; check for hoarseness

Vagus

Head turning, shoulder shrugging (M)

Shrug shoulders and turn head against resistance

Accessory

Tongue movement (M)

Protrude tongue midline; move side to side

Hypoglossal