What does GCS = 3 mean? Describe this scale.
The Glasgow Coma Scale (GCS) was developed in 1974 to describe the level of consciousness. It measures the best eye, verbal and motor responses. Each is graded from worst ( = 1) to best ( 4, 5 and 6 respecively) and the grades added together, such that the lowest possible score is 3 and the highest is 15.
What is the most likely cause of this patient's pontine haemorrhage? What is the differential?
Hypertension is the most likely cause in this age group. Other possibilities include: vascular malformations (cavernous malformations, arteriovenous malformations); tumours (neuroepithelial (primary) brain tumours, metastases).
Large pontine haemorrhage (*) has extended into the forth ventricle (V4), up the aqueduct of Sylvius (AQ) and into the third ventricle (V3). The lateral ventricles (LV) and their temporal horns (TH) are a little prominent, although this is in part due to age related ex vacuo dilatation.