appendix 1 Outline Diagrams of the Brain
appendix 2 Glasgow Outcome Scale
appendix 3 Glasgow Coma Scale
appendix 4 Post Traumatic Amnesia

Appendix 3

Glasgow Coma Scale (GCS)
Reference: Teasdale G, Jennett B: Assessment of coma and impaired consciousness: A practical scale. Lancet 2: 81, 1974.

GCS is used to measure level of responsiveness. It provides a measure of the severity of brain injury (although POST-TRAUMATIC AMNESIA (qv) most also be considered). It also allows the patient to be monitored, as any decline in level of responsiveness would raise the question of whether there were developing intra-cranial complications. Responsiveness is measured in three domains:

EYE OPENING
Spontaneous=4; To speech=3; To pain*=2; Nil=1

BEST MOTOR RESPONSE
Obeys=6; Localizes pain*=5; Withdraws from pain*=4; Abnormal flexion*=3; Extensor response*=2; Nil*=1

VERBAL RESPONSE Orientated=5; Confused conversation=4; Inappropriate words=3; Incomprehensible sounds=2; Nil=1

* A STANDARD BUT HARMLESS PAIN STIMULUS IS ADMINISTERED, USUALLY BY ROLLING AN OBJECT OVER THE EYEBROW, OR TWISTING A NIPPLE.

The total score ranges from 3 (worst) to 15 (best). It has become common to describe a total GCS score after resuscitation as indicating degrees of severity of brain injury as follows:

• 3-5 "very severe"
• 6-8 "severe"
• 9-12 "moderate"
• 13-15 "minor".