Symptoms
The GCS is used to assess symptoms, not to *have* symptoms. It describes the following responses:
Eye Opening Response (E):
4 - Spontaneous – open with blinking at baseline
3 - To verbal command, stimulus, or speech
2 - To pain only (not applied to face)
1 - No response
Verbal Response (V):
5 - Oriented
4 - Confused conversation, but able to answer questions
3 - Inappropriate words
2 - Incomprehensible speech
1 - No response
Motor Response (M):
6 - Obeys commands for movement
5 - Purposeful movement to painful stimulus
4 - Withdraws from pain
3 - Abnormal (spastic) flexion, also called decorticate posture
2 - Extension (rigid) response, also called decerebrate posture
1 - No motor response
Causes
The GCS is not a disease and does not have causes. It is a tool used to assess the level of consciousness in patients with conditions that affect the brain, such as:
Traumatic brain injury (TBI)
Stroke
Brain tumors
Infections (e.g., meningitis, encephalitis)
Metabolic disorders
Seizures
Drug overdose
Hypoxia (lack of oxygen to the brain)
Medicine Used
The GCS is not a disease; therefore, there is no medicine used to treat it directly. However, medications may be used to treat the underlying conditions that affect the patient's level of consciousness. These may include:
Pain medication
Anti-seizure medications
Medications to reduce brain swelling (e.g., mannitol, hypertonic saline)
Antibiotics (for infections)
Reversal agents for drug overdose (e.g., naloxone)
Is Communicable
The GCS is not a disease and therefore is *not* communicable. The underlying conditions that result in low GCS scores may or may not be communicable (e.g., meningitis can be).
Precautions
The GCS itself does not require precautions. However, when assessing a patient with a potential neurological injury or altered mental status, standard precautions should be followed (e.g., hand hygiene, gloves). If the underlying condition is communicable (e.g., meningitis), then appropriate infection control measures should be implemented (e.g., mask, gown).
How long does an outbreak last?
The GCS is not a disease, and there are no outbreaks. The duration of the underlying condition will vary depending on the cause and the effectiveness of treatment.
How is it diagnosed?
The GCS is not diagnosed. It is used to evaluate patients. The underlying conditions that can affect consciousness are diagnosed through:
Clinical examination
Neurological assessment
Imaging studies (e.g., CT scan, MRI)
Laboratory tests (e.g., blood tests, cerebrospinal fluid analysis)
Timeline of Symptoms
The GCS assesses symptoms present in a patient that indicate their level of consciousness. The timeline of how the GCS score changes depends on the underlying condition:
Acute conditions (e.g., TBI, stroke): The GCS score can change rapidly in the initial hours or days.
Progressive conditions (e.g., brain tumor): The GCS score may decline gradually over weeks or months.
Improvement with treatment: The GCS score may improve as the underlying condition is treated.
Important Considerations
The GCS is just one component of a complete neurological assessment.
It should be used in conjunction with other clinical findings.
The GCS should be performed by trained medical personnel.
Certain factors can affect the accuracy of the GCS, such as sedation, intubation, or pre-existing conditions.
Trends in the GCS score over time are more informative than a single score.