Neurological Assessment: GCS, Cranial Nerves, and Reflexes

A neurological examination is a comparison over time, not a single number. The finding that matters most is often the change from the patient's own baseline: a person who is newly slow to answer, needs repeated stimulation, develops a weaker handgrip, or has a different pupil requires a different response even if the total GCS remains above 8. Observe before touching the patient. Note spontaneous eye opening, speech clarity, facial symmetry, limb movement, posture, breathing pattern, and whether the patient tracks people or objects. Confirm identity, explain each manoeuvre, provide adequate light and hearing support, and use an interpreter when language could affect the verbal assessment. A patient should not lose GCS points because the examiner asked questions in an unfamiliar language or failed to account for a hearing aid that was removed. If the patient is acutely unresponsive or deteriorating, use the ABCDE sequence. Assess airway patency, breathing effectiveness, and circulation before spending time on a complete cranial-nerve examination. Suspected trauma also requires spinal precautions until injury has been excluded. Check capillary glucose according to local protocol when altered...