Appendix 3 Guidelines for the Neurological Examination in Patients with Altered Level of Consciousness

Mental Status

1. Level of arousal

2. Response to auditory stimuli (including voice)

3. Response to visual stimuli

4. Response to noxious stimuli (applied centrally and to each limb individually)

Cranial Nerves

1. Response to visual threat

2. Papillary light reflex

3. Oculocephalic (doll’s eyes) reflex

4. Vestibulo-ocular (cold caloric) reflex

5. Corneal reflex

6. Gag reflex

Motor Function

1. Voluntary movements

2. Reflex withdrawal

3. Spontaneous, involuntary movements

4. Tone (resistance to passive manipulation)

Reflexes

1. Deep tendon reflexes

2. Plantar responses

Sensation (to noxious stimuli)