Declining Glasgow Coma Scale (GCS) well explained.


Declining Glasgow Coma Scale (GCS) well explained.

Crl. Misc.10010-B-24

MUHAMMAD RAMZAN VS STATE ETC 

Mr. Justice Muhammad Amjad Rafiq 

11-03-2025 

2025 LHC 915


Declining Glasgow Coma Scale (GCS) indicates a worsening neurological condition due to head injuries, stroke and other brain related issues.


The Glasgow Coma Scale (GCS) is a tool used to assess a patient's level of consciousness by evaluating their eye, verbal, and motor responses, with scores ranging from 3 to 15, where 3 indicates a comatose state and 15 represents normal consciousness. The GCS was developed in 1974 by experts at the University of Glasgow in Scotland. It's a widely used tool for measuring consciousness and coma. It assesses a person's ability to perform eye movements, speak, and move their body. The Glasgow Coma Scale has three categories that apply to a neurological examination. Most of them apply to the brain itself, but some can also involve spinal cord and nerves throughout the body. The GCS is measured with the help of followings; 


Eye response: This relates to how awake and alert you are. 


Motor Response: This part is about how well your brain can control muscle movement. It can also show if there are any issues with the connections between your brain and the rest of your body. 


Verbal response: This tests how well certain brain abilities work, including thinking, memory, attention span and awareness of your surroundings. 


The scores for each category (E, V, M) are added together to give a total GCS score. The GCS score should be recorded individually, for example, E2V3M4 results in a GCS score of 9. The GCS is used to objectively describe the extent of impaired consciousness in all types of acute medical and trauma patients. In the medical context, consciousness has three requirements;

(i) Awake: this includes whether or not you have the ability to wake up because of voice or touch. That’s what makes a coma different from just being asleep

(ii) Alert: this is how responsive you are to people talking to you and if you’re able to understand what’s happening in your immediate surroundings

(iii) Oriented: this means you know who you are, where you’re at, what day it is and other details related to the here and now.


A declining Glasgow Coma Scale (GCS) score, which measures a person's level of consciousness, typically indicates a worsening neurological condition, potentially due to factors like head injury, stroke, or other brain-related issues. Factors that can cause a GCS score to decrease are as under


(i) Traumatic Brain Injury (TBI): Head injuries, including concussions and more severe trauma, can lead to swelling, bleeding, or damage to brain tissue, all of which can impair consciousness and lower the GCS score. 


(ii) Cerebrovascular Accidents (Stroke): Strokes, whether ischemic (due to blocked blood flow) or hemorrhagic (due to bleeding), can disrupt brain function and cause a decline in GCS


(iii) Intracranial Infections or Abscesses: Infections or abscesses within the brain can lead to inflammation and pressure, which can affect brain function and consciousness. 


(iv) Other Neurological Conditions: Conditions like epilepsy, poisoning, or even certain psychiatric disorders can also lead to a reduced level of consciousness and a lower GCS score.  


(v) Physiological Derangements: Factors like hypoxia (low blood oxygen), shock, or hypoglycemia (low blood sugar) can impair brain function and lower the GCS score.  


(vi) Medications and Intoxication: Certain medications, including sedatives, or drug and alcohol intoxication can also depress consciousness and affect the GCS score


(vii)  Intubation: If a patient is intubated and unable to speak, they are evaluated only on the motor and eye-opening response and the suffix T is added to their score to indicate intubation


(viii) Pre-existing conditions: Pre-existing conditions like dementia, speech and hearing impairment can also affect the GCS score.


GCS usually decreases due to head injuries, including concussions and more severe trauma, which can lead to swelling, bleeding, or damage to brain tissue, but in this case no head injury was observed by the doctor. Thus, the GCS is not a perfect tool which can be influenced by various factors, so it should be used in conjunction with other clinical assessments which the doctor has not mentioned in detail, leaving the subject to be scrutinized through examination of doctor as witness during the trial.  

Comments

Post a Comment

Popular posts from this blog

The Woman who takes Khula is also entitled of Dower.

Image
The woman who takes Khula is also entitled of dower. W.P 68712 of 2024 LHC ASIF MEHMOOD VS ADDITIONAL DISTRICT JUDGE ETC 10-04-2025 The Lahore High Court has decided an important legal point regarding women's rights and has ruled that even in the event of termination of marriage on the basis of Khula, a woman is fully entitled to her dower, and the mere taking of Khula cannot be considered a justification for deprivation of this right. This decision was issued by Honorable Justice Raheel Kamran Sheikh on a petition filed by Asif Mahmood. The court issued a detailed eight-page decision in this regard. The petitioner had challenged the decision of the District Court of Sahiwal in which a degree of dower and dowry amount was issued in favor of the defendant (wife) after Khula. The honorable court ruled that if the husband's behavior is such that the wife is forced to take Khula, then in such a case the woman is not only entitled to Khula but also to dower, which is her legitimate ...
Read more

Family Court must consider the financial status of the father when awarding maintenance.

Image
  Family Court must consider the financial status of the father when awarding maintenance. 2009 PLD 760 SC TAUQEER AHMAD QURESHI Vs ADDITIONAL DISTRICT JUDGE, LAHORE In this case, the Supreme Court dealt with the issue of appropriate maintenance allowance for minors granted by the Family Court, particularly focusing on the 20% annual increase in the allowance. The Court ruled that the Family Court's awarding of a 20% annual increase was arbitrary, illegal, and without basis and thus reduced it to 5% annually. Key Legal Issues: •Maintenance allowance for minors as per father's financial status •Family Court's jurisdiction and power to award increases in maintenance •Executability of Family Court decrees •Executing Court's authority in declaring parts of a decree inexecutable Holding: The Supreme Court held that the Family Court's decision to award a 20% annual increase in the minors' maintenance allowance was arbitrary, illegal, and whimsical. The Court reduced t...
Read more

If the Husband dies during Iddat, the Divorced Wife will be Considered Widow

Image
  If the Husband dies during Iddat, the Divorced Wife will be Considered Widow 2017 CLC 516 Mst. ROHEELA YASMIN Versus Ms. NEELOFAR HASSAN The case involves a dispute regarding the inheritance rights of Mst. Roheela Yasmin following the death of her husband, who allegedly divorced her before his death but within the stipulated 90-day period during which he could have revoked the said divorce. The court held that since the divorce had not yet become effective as per S.7 of the Muslim Family Laws Ordinance, 1961, the appellant remained his widow and was entitled to inherit his property. The impugned order was set aside, and the appeal was allowed. Key Legal Issues: • Validity and effectiveness of divorce within the 90-day period. • Right to inheritance under Muslim Family Laws Ordinance. • Procedure for reconciliation in Islamic law. Holding: The court concluded that the divorce pronounced by the deceased husband had not yet become effective as the 90-day period for revocation had no...
Read more