Neuroanatomical Basis of Glasgow Coma Scale—A Reappraisal


Glasgow coma scale is the most cited paper in neurosurgery. It has vast implications in the fields of neurology and neurosurgery. But lack of proper understanding in the neuro-anatomical basis of the score is the Achilles heel in proper utilization of the same. Herein we review the anatomical aspects behind each variable in the score. We also discuss common limitations of the score and highlight future directives to limit the same.

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Munakomi, S. and Kumar, B. (2015) Neuroanatomical Basis of Glasgow Coma Scale—A Reappraisal. Neuroscience and Medicine, 6, 116-120. doi: 10.4236/nm.2015.63019.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Teasdale, G. and Jennett, B. (1974) Assessment of Coma and Impaired Consciousness. A Practical Scale. The Lancet, 2, 81-84.
[2] Teasdale, G., Jennett, B., Murray, L. and Murray, G. (1983) Glasgow Coma Scale: To Sum or Not to Sum. The Lancet, 2, 678.
[3] McNett, M. (2007) A Review of the Predictive Ability of Glasgow Coma Scale Scores in Head-Injured Patients. Journal of Neuroscience Nursing, 39, 68-75.
[4] Miskovic, V. and Keil, A. (2014) Escape from Harm: Linking Affective Vision and Motor Responses during Active Avoidance. Social Cognitive and Affective Neuroscience, 9, 1993-2000.
[5] Gandhi, N.J. and Katnani, H.A. (2011) Motor Functions of the Superior Colliculus. Annual Review of Neuroscience, 34, 205-231.
[6] Schall, J.D. (2001) Neural Basis of Deciding, Choosing and Acting. Nature Reviews Neuroscience, 2, 33-42.
[7] Booth, J.R., Wood, L., Lu, D., Houk, J.C. and Bitan, T. (2007) The Role of the Basal Ganglia and Cerebellum in Language Processing. Brain Research, 1133, 136-144.
[8] Robinson, D.L. and Petersen, S.E. (1992) The Pulvinar and Visual Salience. Trends in Neurosciences, 15, 127-132.
[9] Peschanski, M., Guilbaud, G., Gautron, M. and Besson, J.M. (1980) Encoding of Noxious Heat Messages in Neurons of the Ventrobasal Thalamic Complex of the Rat. Brain Research, 197, 401-413.
[10] Monconduit, L., Bourgeais, L., Bernard, J.F., Le Bars, D. and Villanueva, L. (1999) Ventromedial Thalamic Neurons Convey Nociceptive Signals from the Whole Body Surface to the Dorsolateral Neocortex. The Journal of Neuroscience, 19, 9063-9072.
[11] Esteban, A., Traba, A. and Prieto, J. (2004) Eyelid Movements in Health and Disease. The Supranuclear Impairment of the Palpebral Motility. Neurophysiologie Clinique, 34, 3-15.
[12] Kaas, J.H. (2008) The Evolution of the Complex Sensory and Motor Systems of the Human Brain. Brain Research Bulletin, 75, 384-390.
[13] Mantini, D., Corbetta, M., Romani, G.L., Orban, G.A. and Vanduffel, W. (2013) Evolutionarily Novel Functional Networks in the Human Brain? The Journal of Neuroscience, 33, 3259-3275.
[14] MacKay-Lyons, M. (2002) Central Pattern Generation of Locomotion: A Review of the Evidence. Physical Therapy, 82, 69-83.
[15] Bateman, D.E. (2001) Neurological Assessment of Coma. Journal of Neurology, Neurosurgery & Psychiatry, 71, i13-i17.
[16] Carlson, N.L., Ming, V.L. and DeWeese, M.R. (2012) Sparse Codes for Speech Predict Spectrotemporal Receptive Fields in the Inferior Colliculus. PLoS Computational Biology, 8, e1002594.
[17] Hickok, G. (2009) The Functional Neuroanatomy of Language. Physics of Life Reviews, 6, 121-143.
[18] Fabbro, F., Clarici, A. and Bava, A. (1996) Effects of Left Basal Ganglia Lesions on Language Production. Perceptual and Motor Skills, 82, 1291-1298.
[19] Booth, J.R., Wood, L., Lu, D., Houk, J.C. and Bitan, T. (2007) The Role of the Basal Ganglia and Cerebellum in Language Processing. Brain Research, 1133, 136-144.
[20] Friedemann, P., Olaf, H., Vadim, V.N. and Risto, J.I. (2005) Functional Links between Motor and Language Systems. European Journal of Neuroscience, 21, 793-797,
[21] Green, S.M. (2011) Cheerio, Laddie! Bidding Farewell to the Glasgow Coma Scale. Annals of Emergency Medicine, 58, 427-430.
[22] Bassi, S., Buxton, N., Punt, J.A. and O’Reilly, G. (1999) Glasgow Coma Scale: A Help or a Hindrance? British Journal of Neurosurgery, 13, 526-539.
[23] Malec, J.F., Brown, A.W., Leibson, C.L., Flaada, J.T., Mandrekar, J.N., Diehl, N.N., et al. (2007) The Mayo Classification System for Traumatic Brain Injury Severity. Journal of Neurotrauma, 24, 1417-1424.
[24] Balestreri, M., Czosnyka, M., Chatfield, D.A., Steiner, L.A., Schmidt, E.A., Smielewski, P., et al. (2004) Predictive Value of Glasgow Coma Scale after Brain Trauma: Change in Trend over the Past Ten Years. Journal of Neurology, Neurosurgery & Psychiatry, 75, 161-162.
[25] Buechler, C.M., Blostein, P.A., Koestner, A., Hurt, K., Schaars, M. and McKernan, J. (1998) Variation among Trauma Centers’ Calculation of Glasgow Coma Scale Score: Results of a National Survey. The Journal of Trauma, 45, 429-432.
[26] Moskopp, D., Stähle, C. and Wassmann, H. (1995) Problems of the Glasgow Coma Scale with Early Intubated Patients. Neurosurgical Review, 18, 253-257.
[27] Mena, J.H., Sanchez, A.I., Rubiano, A.M., Peitzman, A.B., Sperry, J.L., Gutierrez, M.I. and Puyana, J.C. (2011) Effect of the Modified Glasgow Coma Scale Score Criteria for Mild Traumatic Brain Injury on Mortality Prediction: Comparing Classic and Modified Glasgow Coma Scale Score Model Scores of 13. The Journal of Trauma, 71, 1185-1193.
[28] Marshall, L.F., Eisenberg, H., Marshall, S.B., Klauber, M.R. and Jane, J.A. (1991) A New Classification of Head Injury Based on Computerized Tomography. Journal of Neurosurgery, 75, S14-S20.
[29] McNarry, A.F. and Goldhill, D.R. (2004) Simple Bedside Assessment of Level of Consciousness: Comparison of Two Simple Assessment Scales with the Glasgow Coma Scale. Anaesthesia, 59, 34-37.
[30] Wijdicks, E.F., Bamlet, W.R., Maramattom, B.V., Manno, E.M. and McClelland, R.L. (2005) Validation of a New Coma Scale: The FOUR Score. Annals of Neurology, 58, 585-593.

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