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Evaluation of a patient's consciousness and its evolution over time

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  • Score from 3 to 15
    • Under 8: coma
    • Between 12 and 8: critical, case-by-case evaluation
  • Limits
    • Pediatric patients (adapted scale)
    • Deaf patients
    • Patients with paralysis

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Glasgow Scale for Adults

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Glasgow Coma Scale
123456
EyesDoes not open eyesOpens eyes in response to painful stimuliOpen eyes in response to voiceOpens eyes spontaneously
VerbalMakes no soundsIncomprehensible soundsUtters inappropriate wordsConfused, disorientedOriented converses normally
MotorMakes no movementsExtension to painful stimuli (decerebrate response)Abnormal flexion to painful stimuli (decorticate response)Flexion/ withdrawal to painful stimuliLocalizes painful stimuliObeys commands
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Glasgow Scale for Pediatric Patients (under 5 Years)

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Pediatric Glasgow Coma Scale
123456
EyesNo eye openingEye opening to painEye opening to noiseEyes open spontaneously
Verbal
0–23 monthNo verbal responseGrunts or is agitated or restlessPersistent inappropriate crying when painIrritated, crying but consolableNormal: smiles or coos appropriately
2–5 yearsNo verbal responseGruntsPersistent cries or screamsInappropriate wordsAppropriate words or phrases
MotorNo motor responseStereotyped extension to painStereotyped flexion to painWithdrawal from painWithdrawal from touchSpontaneously
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NB: applied pain: noxious stimulus in an uninjured area.

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Example: nail bed pressure with a hard object, or pressure behind vertical branch of mandible.

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Glasgow scale insufficient when deep coma because spontaneous eye opening is insufficiently indicative of brainstem arousal system activity

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Better predictive value of cerebral trunk function than motor response

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Glasgow–Liège Scale
ReflexScore
Fronto-orbicular5
Vertical oculocephalic4
Pupillary light3
Horizontal oculocephalic (or oculovestibular)2
Oculocardiac1
No brainstem reflex0

Score from 3 to 20 (Glasgow score + 0–5)

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  • Fronto-orbicular = percussion of the glabella (area of the forehead between the eyebrows) produces contraction of the orbicularis oculi muscle
  • Oculocephalic reflex (doll's eyes) = present when deviation of at least one eye can be induced by repeated neck flexion and extension (vertical) or side-to-side movement (horizontal)
  • If the reflexes are absent or cannot be tested (e.g., immobilized cervical spine), an attempt is made to elicit ocular motion by external auditory canal irrigation using iced water (i.e., oculovestibular reflex testing); contra-indicated if tympanic perforation
  • Oculocardiac reflex = present when pressure on the eyeball causes the heart rate to slow down
  • The best response determines the brainstem reflex score. The selected reflexes disappear in descending order during rostro–caudal deterioration

1. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974 Jul;2:81–84.   [PubMed: 4136544]

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