Glasgow Coma Scale Flashcards
(44 cards)
Chronological order: Levels of consciousness
1) Alert & oriented
2) Confusion/Disoriented
3) Somnolence/Drowsiness
4) Obtundation
5) Stuporous
6) Comatose
State of strong desire for sleep or drowsiness
Somnolence
State where you are less aware of your surroundings
Obtundation/Lethargy
Partial or nearly complete unconsciousness
Stupor
Consciousness has 2 dimensions:
Arousal and Cognition
A primitive function sustained by deep brainstem and medial thalamic structures
Arousal
Require an intact cerebral cortex and major subcortical nuclei
Cognition
Patient is awake and aware of self and environment. When spoken to in a normal voice, patient looks at you and responds fully and appropriately to the stimuli
Alertness
When spoken to in a loud voice, patient appears drowsy but opens eyes and looks at you, responds to questions, and then fall asleeps
Lethargy
When shaken gently, patient opens eyes and looks at you but responds slowly and is somewhat confused. Alertness and interest in environment are decreased
Obtundation
Patient arouses from sleep only after painful stimuli. Verbal responses are slow or absent. Patient lapses into unresponsiveness when stimulus stops. Patient has minimal awareness of self or environment
Stupor
Despite repeated painful stimuli, patient remains unarousable with eyes closed. No evident response to inner need or external stimuli is shown.
Coma
It is the severest form of impairment of arousal; simply the inability to obey commands, speak or open the eyes to pain
Coma
Coma is defined as, except: A. state of unconsciousness of <6hrs B. GCS = 8 C. fails to respond "normally" to painful stimulus, light or sound D. no normal sleep-wake cycle
A.
3 prerequisites for coma/loss of consciousness
- Diffuse lesion of both cerebral hemispheres (cortical or subcortical white matter)
- Bilateral diencephalic dysfunction (“mus”)
- Brainstem (RAS)
The ff are toxic or metabolic causes of coma, except: A. hypercalcemia B. vasculitis C. meningitis D. epidural hematoma
D
Syndrome which is usually caused by clogging of the BASILAR artery leading to an infarct; patient is aware but cannot move or communicate verbally due to complete paralysis of nearly all voluntary muscles in the body except for vertical eye movements and blinking
Locked-In Syndrome
Pseudocoma
Locked-in syndrome
Psychiatric: catatonia conversion syndromes
Neuromuscular weakness: myasthenia gravis, Guillain-Barre syndrome
Results from damage to both or one corticospinal tract. Posture is characterized with the arms ADDUCTED and FLEXED, wrists and fingers are FLEXED on chest, and the legs are stiffly EXTENDED and INTERNALLY rotated with PLANTAR FLEXION of the feet
Decorticate Posture (M3)
Results from damage to upper brainstem. Posture is characterized with the arm ADDUCTED and EXTENDED, wrists PRONATED and fingers are FLEXED. The legs are stiffly EXTENDED with plantar flexion of the feet
Decerebrate posture (M2)
Decerebrate is higher than decorticate in the GCS (T or F)
F
- M2 : decerebrate
- M3 : decorticate
a.k.a. flexor posturing or “mummy baby”
Decorticate posture (M3)
Disinhibition of RUBROSPINAL and VESTIBULOSPINAL tracts
Decorticate
Disinhibition of RETICULOSPINAL and VESTIBULOSPINAL tracts
Decerebrate
