Head trauma in the feline patient – an update

Figures & data

Figure 1. This dog was involved in a road traffic accident

Table 1. Small animal coma scale

Score	Motor Activity	Brainstem Reflexes	Level of Consciousness
6	Normal gait, normal spinal reflexes	Normal pupillary light responses and oculocephalic reflexes	Occasional periods of alertness and responsive to environment
5	Hemiparesis, tetraparesis or decorticate activity	Slow pupillary light responses and normal to reduced oculocephalic reflexes	Depression or delirium, capable of responding to environment but response may be inappropriate
4	Recumbent, intermittent extensor rigidity	Bilateral, unresponsive miosis with normal to reduced oculocephalic reflexes	Semi-comatose, responsive to visual stimuli
3	Recumbent, constant extensor rigidity	Pinpoint pupils with reduced-to-absent oculocephalic reflexes	Semi-comatose, responsive to auditory stimuli
2	Recumbent, constant extensor rigidity with opisthotonus	Unilateral unresponsive mydriasis with reduced-to-absent oculocephalic reflexes	Semi-comatose, responsive only to repeated noxious stimuli
1	Recumbent, hypotonia of muscles, depressed or absent spinal reflexes	Bilateral, unresponsive mydriasis with reduced-to-absent oculocephalic reflexes	Comatose, unresponsive to repeated noxious stimuli

Key: 3 – 8 indicates worst prognosis; 9 – 14 indicates poor-to-fair prognosis; 15 – 18 indicates a good prognosis.

Table 2. Glasgow Coma Scale (GCS)

Score	Movement	Speech	Opening Eyes
6	Obeys commands	n/a	n/a
5	Movement localised to stimulus	Orientated response	n/a
4	Withdraws	Confused conversation	Spontaneous
3	Abnormal muscle bending and flexing	Inappropriate words	To speech
2	Involuntary muscle straightening and extending	Incomprehensible sounds	To pain
1	None	None	None

This human scoring system is designed to assess severity of coma based upon a patient's ability to move, speak and open their eyes. A low GCS score indicates severe loss of consciousness (from www.headwayorg.uk, accessed 2014).

Figure 2. Pupillary size and response to light should be monitored

Figure 3. Diagram of opisthotonus