Neurological Assessment: GCS, Cranial Nerves, and Reflexes

A neurological assessment is most useful when it answers two questions: What is the patient’s neurological state now, and has it changed? A single normal finding does not protect a patient from a rapidly evolving intracranial problem; the trend often carries more meaning than the isolated score. Before beginning detailed testing, observe the patient. Are they awake, making eye contact, speaking clearly, moving both sides spontaneously, and breathing effectively? A new change in attention, speech, facial symmetry, gaze, or limb movement may be more significant than a mildly abnormal reflex. Use an ABCDE approach, with airway and breathing taking priority over the examination itself. Reduced consciousness can remove the gag and cough responses, allowing the tongue or secretions to obstruct the airway. Assess respiratory effort and oxygenation, circulation, and point-of-care blood glucose because hypoglycaemia can resemble neurological deterioration. If trauma is possible, protect the cervical spine while assessing. Establish the patient’s usual neurological findings whenever possible. Record level of consciousness, GCS components, pupil size and reaction, speech, facial symmetry, limb movement, sensation when indicated, and relevant reflexes. Compare right with...