Concussion (Commotio Cerebri): Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • Assessment of consciousness using the Glasgow Coma Scale (GCS) (see below).
  • General physical examination – including blood pressure, pulse, body weight, height; furthermore:
    • Inspection (viewing).
      • Skin and mucous membranes
      • Abdomen (abdomen)
        • Shape of the abdomen?
        • Skin color? Skin texture?
        • Efflorescences (skin changes)?
        • Pulsations? Bowel movements?
        • Visible vessels?
        • Scars? Hernias (fractures)?
    • Auscultation (listening) of the heart.
    • Auscultation of the lungs
    • Palpation (palpation) of the abdomen (abdomen) (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, kidney bearing knocking pain?)
  • Neurological examination [due topossible symptoms:
    • Amnesia, retrograde and antegrade – amnesia preceding and following the triggering event in time (memory impairment).
    • Cephalgia (headache)
    • Vertigo (dizziness)]

    [due todifferential diagnoses:

    • Compressio cerebri (cerebral contusion).
    • Contusio cerebri (cerebral contusion)]

Square brackets [ ] indicate possible pathological (pathological) physical findings.

Glasgow Coma Score (GCS) – scale for estimating a disorder of consciousness:

Criterion Score
Eye opening spontaneous 4
on request 3
on pain stimulus 2
no reaction 1
Verbal communication conversational, oriented 5
conversational, disoriented (confused) 4
incoherent words 3
unintelligible sounds 2
no verbal reaction 1
Motor response Follows prompts 6
Targeted pain defense 5
untargeted pain defense 4
on pain stimulus flexion synergisms 3
on pain stimulus stretching synergisms 2
No response to pain stimulus 1

Assessment

  • Points are awarded separately for each category and then added together. The maximum score is 15 (fully conscious), the minimum 3 points (deep coma).
  • If the score is 8 or less, very severe brain dysfunction must be assumed and there is a risk of life-threatening respiratory failure.
  • With a GCS less than or equal to 8, securing the airway by endotracheal intubation (insertion of a tube (hollow probe) through the mouth or nose to secure the airway) must be considered.