LEVEL OF CONSCIOUSNESS
15 – Glasgow Coma Scale Score

LANGUAGE
Comprehension
Give three commands:

1. ‘Stick out your tongue’ or “Close your eyes’
2. ‘Point to the door’
3. ‘Place left/right hand on left/right ear and then on left/right knee (using unaffected side)

   Score on number correctly followed:
   0 = 5
   1 = 4
   2 = 2
   3 = 0

Naming
Ask patient to name the following items:

1. Watch or Belt
2. Watch strap or Belt buckle
3. Index finger or Ring finger

Score on number correctly named:
0 = 5
1 = 4
2 = 2
3 = 0

Repetition
Ask the patient to repeat the following:

1. A single word, such as ‘dog’ or ‘cat’
2. ‘The president lives in Washington’
3. ‘No ifs, ands, or buts’

Score on number repeated:
0 = 5
1 = 4
2 = 2
3 = 0

Fluency
Score according to patient’s spontaneous speech fluency, or
ask patient to name as many words as he can within one minute beginning with the letter ‘A’ (excluding proper names)

Score as:
5 = Essentially no verbal output
3 = Moderately loss; inability to recognize stationary finger, sees moving finger
1 = Mild loss; defect to double simultaneous stimulation
0 = Normal

OTHER CORTICAL FUNCTIONS AND CRANIAL NERVES
Visual fields
Test clinically and score hemi-field loss as:

3 = Severe loss; inability to recognize moving hand, no response to threat
2 = Moderate loss; inability to recognize stationary finger, sees moving finger
1 = Mild loss: defect to double simultaneous stimulation
0 = Normal

Gaze
Score eye movements:

2 = Gaze play, or persistent deviation
1 = Gaze preference, or difficulty with far lateral gaze
0 = Normal

Facial expression
Score movement:

3 = Severe weakness; drooling
2 = Moderate loss; asymmetry at rest
1 = Mild weakness; asymmetry on similing
0 = Normal

Dysarthria
Score talking:

2 = Severe dysarthria
1 = Moderate dysarthria
0 = Normal

Dysphagia
Score swallow of glass water:

2 = Severe dysphagia
1 = Moderate dysphagia
0 = Normal

Neglect syndrome
Ask about weak limbs, and ask to bisect a line 7 inches (20 cm) long on piece of paper
in visual midline

Score:
2 = Anosagnosia, or denial of body part
1 = Consistently bisects line towards ‘good’ side of body
0 = Bisects line in middle

Visual construction
Ask patient to copy three figure given, and score:

3 = Unable to copy any figure
2 = Can copy a square
1 = Can copy a ‘Greek Cross’ (‘Cross of St. George’)
0 = Can copy 3D drawing of cube

MOTOR FUNCTION

Arm, proximal

Arm, distal

Leg, proximal

Leg, distal

All scored 0-7 as:
7 = No movement (MRC 0)
6 = Trace movement only (MRC 1)
5 = Motion without gravity only (MRC 2)
4 = Moves against gravity but not against resistance (MRC 3)
3 = Moderate weakness (MRC 4 -)
2 = Mild weakness (MRC 4)
1 = Positive drift of arm/leg (MRC 4 +)
0 = Normal (MRC 5)

Deep tendon reflexes

2 = Hypoactive or hyperactive
0 = Normal

Pathologic reflexes

2 = Babinski (plantar) and another abnormal
1 = Babinski (plantar) or another abnormal
0 = Normal

Muscle tone

2 = Increased or decreased
0 = Normal

Gait
Test ability to stand and walk, and score:

6 = Unable to stand unsupported or cannot evaluate
5 = Can stand with support but cannot walk
4 = Severely abnormal; walking distance limited even with support (from aid or person)
3 = Moderately abnormal; no assistance required (apart from a stick/cane), but distance limited
2 = Mildly abnormal (weak, uncoordinated); can walk independently but slowly
1 = Minimally abnormal, no reduction in speed or distance
0 = Normal

SENSORY
Primary modalities (of affected side only), arm
Test touch, pain and score as:

4 = Anaesthesia
3 = Severe hypaesthesia
2 = Moderate hypaesthesia or deficit only; or extinction to double simultaneous stimulation
1 = Mild hypaesthesia or dysaesthesia
0 = Normal

Stereoagnosis
Test ability to distinguish two coins and a key, and score:

3 = Unable to achieve any distinctions
2 = Can distinguish a coin from a key
1 = Can distinguish between two very different sized coins (penny and ten-pence piece, penny and quarter)
0 = Can distinguish between two similar sized coins (penny and nickel, or two-pence piece and ten-pence piece)

 

OVERALL TOTAL: ____

References

Adams RJ, Meador KJ, Sethi KD, Grotta JC, Thomson DS. “Graded neurologic scale for use in acute hemispheric stroke treatment protocols.”
Stroke. 1987;18:665-9.