Neurosurgery

GCS

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Q. Best predictor in  Glascow coma scale (GCS) 

A. Eye opening
B. Motor response
C. Verbal response
D. All

Ans ) B, Motor response

In the Glasgow Coma Scale (GCS), motor response is considered the best predictor of patient outcomes, especially in assessing the severity of brain injury. This is because motor response correlates strongly with neurological function and brainstem activity, providing a more reliable indicator of the patient's level of consciousness and prognosis.

Why Other Choices Are Incorrect:

  1. A. Eye Opening:
    Eye opening is important but is less specific as a predictor because it can be influenced by factors like sedation, drugs, or environmental stimulation. It is useful for initial assessment but not as accurate in determining long-term outcomes.
  2. C. Verbal Response:
    Verbal response can be influenced by factors like intubation, sedation, or pre-existing conditions affecting speech. It is less reliable in predicting outcomes in patients with severe head injuries, especially when they are unable to speak due to other medical interventions.
  3. D. All:
    While all components of the GCS are valuable in assessing consciousness, motor response alone has been shown to be the strongest predictor of outcome, making it the primary focus when assessing prognosis in severe head injuries.

 

Spinal cord injury

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Q) Out of the following, which patient requires spinal immobilization the most?

A. 22-year-old female involved in a high-speed motor vehicle collision who complains of back pain but has no numbness

B. 16-year-old male who jumped from a 6 ft height and landed on both feet, denies back pain and weakness

C. Gunshot injury

D. Abdominal injury

A. 22-year-old female involved in a high-speed motor vehicle collision with back pain

Spinal immobilization is most indicated when there's a high-risk mechanism of injury with suggestive symptoms, such as midline spinal pain or neurological signs.

  • A involves a high-energy mechanism (MVC) and reported back pain, which is a clear indication for spinal immobilization per NEXUS and Canadian C-spine rules.

  • B has a lower-risk mechanism and no symptoms; thus, spinal immobilization is generally not needed.

  • C – Gunshot wounds may or may not need spinal immobilization depending on location and neurological findings; not always indicated unless spinal structures are involved.

  • D – Isolated abdominal trauma is not an indication for spinal immobilization unless there’s evidence of spinal involvement.

  • Mechanism of injury 
    1. Blunt trauma - Direct impingement, Ischemia, compression or bleeding 
    2. Penetrating - Laceration of spinal cord

    Chance fracture - is a type of spinal cord fracture in which there is transverse fracture of all vertebral elements

    Management

    1 Complete immobilisation

    2. Management of associated neurogenic shock ( due to loss of sympathetic tone) with vasopressors  and fluids

Examination of cranial nerves in head injury

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Q) Gaze paresis is seen after head injury? What is responsible for this

a) Facial nerve injury

b) Vestibulo cochlear nerve injury

c) Brain stem dysfunction

d) Optic nerve injury

 

Gaze paresis is inability to produce horizontal eye movements in one or both directions. Examination of cranial nerves in head injury is very important to fully assess the extent of injury.

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