Neurological Assessment - Part 2: Glasgow Coma Scale & Cranial Nerves

Glasgow Coma Scale (GCS)

• Purpose: Simple tool to measure consciousness impairment.
• History: Developed in 1974, used to assess consciousness in patients objectively.
• Components:
  • Eye Opening:
    • Spontaneous: Score 4
    • To speech: Score 3
    • To pain: Score 2
    • None: Score 1
    • Closed due to physical reasons: Recorded as 'C'
  • Best Verbal Response:
    • Oriented: Score 5
    • Confused: Score 4
    • Inappropriate words: Score 3
    • Incomprehensible sounds: Score 2
    • No response: Score 1
  • Best Motor Response:
    • Obeys commands: Score 6
    • Localizes pain: Score 5
    • Withdraws from pain: Score 4
    • Abnormal flexion (decorticate): Score 3
    • Abnormal extension (decerebrate): Score 2
    • No motor response: Score 1
• Total Score: 3 - 15
  • 14-15 indicates no impairment
  • Less than 8 considered comatose
  • Less than 10 should be reported

Cranial Nerve Assessment

• Purpose: Provides information about brain stem function.

Cranial Nerves Overview

• Mnemonic for order: On Old Olympus Towering Top A Thinning German Butz Of Hops
• Mnemonic for function: S (Sensory), M (Motor), B (Both)

Detailed Cranial Nerve Assessment

1. Cranial Nerve I: Olfactory

   • Function: Sensory - Smell
   • Assessment: Identify common odors
   • Note: Not routinely tested unless suspected loss of smell

2. Cranial Nerve II: Optic

   • Function: Sensory - Vision
   • Assessment: Snellen chart, visual field testing, color vision, red reflex

3. Cranial Nerve III: Oculomotor

   • Function: Motor - Eye movement
   • Assessment: Eyelid drooping, PERLA, EOM

4. Cranial Nerve IV: Trochlear

   • Function: Motor - Downward, inward eye movement
   • Assessment: EOM

5. Cranial Nerve VI: Abducens

   • Function: Motor - Lateral eye movement
   • Assessment: EOM

• Cranial Nerves III, IV, VI are tested together through EOM and PERLA.

5. Cranial Nerve V: Trigeminal
   • Function: Both - Face sensation, chewing
   • Assessment:
     • Sensory: Light, dull, sharp sensations on face
     • Motor: Jaw movement, corneal reflex

Summary

• The Glasgow Coma Scale provides a standardized method to assess consciousness levels in patients and is essential in evaluating and communicating the neurological state.
• Cranial nerve assessments involve memorization and understanding of sensory and motor functions to evaluate brain stem health.

Note: The lecture encourages watching a supplementary video on the Glasgow Coma Scale for better understanding.