Types of Cranioencephalic Trauma

The mechanism of brain trauma occurs when inertia causes the brain to hit the skull from the blunt impact. The brain damage will depend on the force of the impact and whether or not the skull has suffered a fracture.

Head injuries are divided into three degrees according to their seriousness: mild or concussion, moderate, and severe. To find out what type of injury a person with a head injury has, a scale of neurological response is used. It is called the Glasgow Scale as it was described by two neurosurgeons at the University of Glasgow in 1974. The scale measures the neurological response in its visual, oral, and motor parts. It is a very important tool that everyone should know since through it, the degree and evolution of a cranioencephalic trauma is diagnosed in addition to giving you an objective view of the severity.

GLASGOW COMA SCALE:

1 2 3 4 5 6

EYE Does not open eyes Opens eyes in response to pain Opens eyes in response to voice Opens eyes spontaneously N/A N/A

VERBAL Makes no sounds Makes sounds Words Confused, disoriented Oriented, converses normally N/A

MOTOR Makes no movements Extension to painful stimuli (decerebrate response) Abnormal flexion to painful stimuli (decorticate response)

Flexion / withdrawal to painful stimuli Localizes to painful stimuli

Obeys commands

a) Scoring

Eye Response (E)

1. No opening of the eyes: severe damage 2. Eyes opening in response to pain stimulus. A pain stimulus, such as squeezing the fingernail, is enough to see if there is a response. The stimuli could be on any limb. 3. Eyes opening to speech. Not to be confused with the awakening of a sleeping person, such people receive a score of 4, not 3. 4. Eyes opening spontaneously Maximum score: 4 points

Verbal Response (V)

1. No verbal response: severe damage

2. Incomprehensible sounds, like moaning 3. Inappropriate words. Random speech but no conversational exchange. Can’t articulate a sentence 4. Confused. The person responds to questions coherently, but there is disorientation and confusion. 5. Oriented. The person responds coherently and appropriately to questions such as the person’s name and age, where they are and why, the year, month, etc. Maximum score: 5

Motor Response (M)

1. No motor response: indicative of severe damage 2. Decerebrate posturing accentuated by pain. Instead of “escaping” the painful stimulus, he seems to be looking for it. For example, when stimulating the sole of the foot, the normal reflex is to shrink it to protect. The patient who is decerebrate has the opposite response by opening the sole, as if waiting for another stimulus. 3. Decorticate posturing accentuated by pain, called a flexor response because the flexor muscles are active. For example, flexion of forearm and wrist with clenched fist 4. Withdrawal from pain, absence of abnormal posturing, unable to lift hand and locate the painful stimuli 5. Localizes to pain with the hand 6. Obeys commands Maximum score: 6

b) Interpretation

Once we have our score, we can know how serious the traumatized patient’s injury is. The maximum score, which indicates that the patient is very serious, is 15, and the minimum, a totally oriented patient with no apparent injury, is 3. According to the calculated score, brain injuries are classified as follows: • Severe: < 8–9 • Moderate: 8 or 9–12 • Minor: ≥ 13 In the moderate and mild grades, you should retake the test within four hours of the trauma. In the event of a moderate trauma, it is advisable to notify the doctor, but it is not absolutely necessary to transfer the person to a health center.

Severe trauma in its great majority requires intensive care and intubation; therefore an ambulance should be called immediately as the patient must go to the health center. The care required cannot be given at home.