Glasgow Coma Scale Notes

Glasgow Coma Scale

Introduction

The Glasgow Coma Scale (GCS) is a neurological scale used to assess the level of consciousness in patients with acute brain injury. It evaluates eye-opening, verbal response, and motor response.

Components of the Glasgow Coma Scale

The GCS consists of three main components:

• Eye-opening (E)

• Verbal response (V)

• Motor response (M)

Eye-Opening (E)

This component assesses the patient's eye-opening ability based on different stimuli:

• Spontaneous: 4

• Response to speech: 3

• Response to pain: 2

• Nil (no response): 1

Verbal Response (V)

This component evaluates the patient's verbal responses:

• Oriented: 5

• Confused conversation: 4

• Inappropriate words: 3

• Incomprehensible sounds: 2

• Nil (no response): 1

Motor Response (M)

This component examines the patient's motor responses to commands or painful stimuli:

• Obeys commands: 6

• Localizes to pain: 5

• Withdraws from pain: 4

• Abnormal flexor response (Decorticate): 3

• Extensor response (Decerebrate): 2

• Nil (no response): 1

Calculating the Glasgow Coma Scale (GCS) Score

The GCS score is calculated by summing the scores from each of the three components (Eye-opening, Verbal response, and Motor response). The total score ranges from 3 to 15.

GCS = E + V + M

Interpretation of GCS Scores

The GCS score indicates the severity of a brain injury:

• Severe brain injury: GCS score of 3-8

• Moderate head injury: GCS score of 9-12

• Mild head injury: GCS score of 13-15

A GCS score of 3 indicates the lowest possible score and reflects severe brain injury or deep coma.

Posturing

Decorticate Posturing

• Characterized by the hands held to the core.

• Abnormal flexor response.

Decerebrate Posturing

• Characterized by the arms extended.

• Extensor response

Examples of GCS Assessment

Example 1

A patient opens their eyes spontaneously, is oriented, and obeys commands.

• Eye-opening: Spontaneous = 4

• Verbal response: Oriented = 5

• Motor response: Obeys commands = 6

• Total score: 4 + 5 + 6 = 15

The GCS score is 15.

Example 2

A patient opens their eyes to painful stimuli, uses inappropriate words, and withdraws from pain.

• Eye-opening: To pain = 2

• Verbal response: Inappropriate words = 3

• Motor response: Withdraws to pain = 4

• Total score: 2 + 3 + 4 = 9

The GCS score is 9.