Introduction to Neuropathology Key Terms

Neuropathology is a field of study that focuses on the diseases and disorders of the nervous system. Understanding the following key terms helps nurses provide better care to clients with neurological conditions, communicate effectively with other health care providers, and identify potential complications or changes in a client’s condition.

• Glasgow Coma Scale (GCS): A scoring system used to assess the level of consciousness of a person after a head injury or other neurological condition. The GCS measures eye opening, verbal response, and motor response, and scores range from three (indicating severe brain injury) to fifteen (normal). GCS should be assessed on every client as changes can indicate potential complications.
• Locked-in syndrome: A condition in which a person is aware and awake but unable to move or communicate except through eye movements.
• Vegetative state: A condition in which a person is awake but shows no signs of awareness or response to external stimuli.
• Level of consciousness: A measure of a person’s awareness of their surroundings and ability to respond to stimuli. It is often assessed using the Glasgow Coma Scale.
• Brain death: A complete and irreversible loss of brain function, including the brainstem, which controls vital functions such as breathing and heart rate. Brain death is considered legal death in most countries.

Glasgow Coma Scale

The Glasgow Coma Scale (GCS) is a neurological assessment tool commonly used in healthcare settings to evaluate the level of consciousness and neurological function of patients who have suffered from a head injury or other neurological condition. As a nursing student, it is essential to understand the GCS and how it is used in patient care.

It is a standardized tool that uses a numerical score to rate a patient’s level of consciousness based on their eye opening, verbal response, and motor response. The scores range from three to fifteen, with fifteen indicating that the client is fully alert and responsive, and three indicating that the client is unresponsive.

The three components of the GCS are:

1. Eye Opening: This component evaluates the client’s ability to open their eyes spontaneously or respond to a verbal or painful stimulus. Scores range from one to four, with one indicating no response and four indicating the client can open their eyes spontaneously.
2. Verbal Response: This component evaluates the client’s  ability to speak and respond to verbal stimuli. Scores range from one to five, with one indicating no response and five indicating the client is alert and oriented.
3. Motor Response: This component evaluates the client’s ability to move their limbs in response to pain or commands. Scores range from one to six, with one indicating no response and six indicating the client can follow commands and move their limbs purposefully.

The scores for each component are added together to give a total score, which ranges from three to fifteen. The higher the score, the better the client’s neurological function.

Locked In Syndrome

Locked-In Syndrome (LIS) is a rare neurological condition that results from damage to the brainstem, specifically the pons, which controls movement and sensation in the body. This damage causes paralysis of all voluntary muscles in the body, including those involved in speech and breathing. 

However, the person remains fully conscious and aware of their surroundings, and their cognitive functions, including memory and reasoning, remain intact.

Nursing care for a client with Locked-In Syndrome involves addressing their physical and emotional needs. Clients with LIS require round-the-clock care, as they cannot move or speak, and are at risk of complications such as pressure ulcers, pneumonia, and other respiratory infections. 

Nurses need to carefully monitor the client’s vital signs, respiratory status, and skin integrity, and provide appropriate interventions as needed.

Vegetative State

A vegetative state refers to a condition in which a person is awake but lacks awareness of their surroundings and themselves. This is a state of severe impairment of consciousness that can result from various causes, such as traumatic brain injury, stroke, or lack of oxygen to the brain. 

In a vegetative state, clients may exhibit reflexive movements, such as eye blinking or yawning, but do not respond to stimuli, communicate, or show purposeful behaviors.

Level of Consciousness

The level of consciousness refers to the degree of awareness that an individual has of their surroundings and themselves. This includes various components such as arousal, attention, cognition, and awareness of the environment. The level of consciousness can range from fully alert and oriented to a coma or even brain death.

Brain Death

Brain Death is a complete and irreversible loss of brain function. This condition is determined by clinical and laboratory tests and confirmed by the absence of brainstem reflexes, including the absence of spontaneous breathing. Brain death is considered the point of legal death in many countries and is irreversible.

• Flat EEG – Electroencephalography
• No brain stem reflexes
• No spontaneous respirations
• Must be evaluated twice by different providers