*Worst score is 3 points, and best score is 15 points. With endotracheal intubation, the highest score is 11.
BRAIN DEATH
The Uniform Determination of Death Act states the following: “An indi-
vidual who has sustained either 1) irreversible cessation of circulatory
and respiratory functions, or 2) irreversible cessation of all functions of
the entire brain, including the brainstem, is dead.” (28). The second
requirement in this statement is the purpose of the brain death determi-
nation described here.
Brain death is not a common consequence of the conditions listed in
Figure 44.1, and is most often the result of traumatic brain injury and
intracerebral hemorrhage, where increased intracranial pressure results
in cessation of blood flow to all areas of the brain (29).
Diagnosis
A checklist for the diagnosis of brain death in adults is shown in Table
44.5 (30–32). There is a lack of consensus about minor aspects of the brain
810
Nervous System Disorders
Points
Eye Opening:
Spontaneous
4
To speech
3
To pain
2
None
1
❏
Points
Verbal Communication:
Oriented
5
Confused conversation
4
Inappropriate but recognizable words
3
Incomprehensible sounds
2
None
1
❏
Points
Motor Response:
Obeys commands
6
Localizes to pain
5
Withdraws to pain
4
Abnormal flexion (decorticate response)
3
Abnormal extension (decerebrate response)
2
No movement
1
❏
Points
Glasgow Coma Score (Total of 3 scales)*
❏
Points
Table 44.4
The Glasgow Coma Scale and Score
