GCS and Misc Neurology Flashcards
What are the 3 components of the GCS?
How many points is each one worth?
Eye (4)
Verbal (5)
Motor (6)
Describe how to measure the GCS.
Eye (4): 4 - spontaneous 3 - on verbal command 2 - on pain (supraorbital pressure) 1 - none
Verbal (5): 5 - orientated to time/place/person 4 - confused 3 - inappropriate 2 - incomprehensible sounds 1 - none
Motor (6): 6 - obeys commands 5 - localises to pain (supraorbital pressure) 4 - flexion 3 - abnormal flexion 2 - abnormal extension 1 - none
List 1 instance in which each of the GCS categories (eyes/verbal/motor) cannot be assessed.
How would you note this in the GCS score?
Eyes - when swollen shut; add “C”
Verbal - when intubated; add “T”
Motor - when patient has been given muscle relaxants
What is the definition of a coma, in terms of the GCS?
Inability to obey commands
Inability to speak
Inability to open eyes to pain
Describe the usual classification of TBI according to GCS.
Minor - GCS 14-15
Moderate - GCS 9-13
Severe - GCS <8
List 8 possible causes of Horner’s syndrome.
Congenital Apical lung tumour Brainstem stroke Cluster headache Multiple sclerosis Carotid artery dissection Cervical rib compression Syringomyelia
Which 4 cranial nerves are affected in cavernous sinus lesions?
What other feature would you see?
3, 4, 5, 6
Horner’s syndrome
Which 4 cranial nerves are affected by superior orbital fissure lesions?
3, 4, 5, 6
Which 3 cranial nerves are affected by cerebellopontine angle lesions?
5, 7, 8
Which 3 cranial nerves are affected by jugular foramen lesions?
9, 10, 11
Which 4 cranial nerves are affected by bulbar/pseudobulbar palsy?
9, 10, 11, 12
What are the features of bulbar palsy? (4)
What is this caused by? (4)
FEATURES: Nasal dysarthria Dysphagia (with nasal regurgitation) Tongue atrophy Tongue fasciculations
CAUSED BY: LMN lesion Brainstem stroke Guillain-Barre syndrome Myasthenia gravis
What are the features of pseudobulbar palsy? (3)
What is this caused by? (4)
FEATURES:
Spastic dysarthria
Slow/limited tongue movements
Possible “pseudobulbar” effect
CAUSED BY: UMN lesions Stroke Multiple sclerosis Space occupying lesions
What are the features of internuclear ophthalmoplegia? (2)
What is this caused by? (1)
Which condition is this commonly associated with?
FEATURES:
No adduction of affected eye
Nystagmus (on lateral gaze) of contralateral eye
CAUSED BY:
Medial longitudinal fasciculus lesion (connecting 3rd and 6th nerve nuclei)
ASSOCIATED WITH:
Multiple sclerosis
What causes bitemporal hemianopia?
Lesions in the optic chiasm
What causes contralateral homonymous hemianopia? (2)
Optic tract lesions
Entire primary visual cortex lesions
What causes monocular visual field loss?
Optic nerve lesions
