Table 2 . The modified Glasgow Coma Scale . A score is given in each category . The total score can be used to assess the severity of neurological signs and monitor improvement or deterioration [ 29 ] .
Assessment parameter Score
Motor activity |
Normal gait , normal spinal reflexes |
6 |
|
Hemiparesis , tetraparesis or decerebrate activity |
5 |
|
Recumbent , intermittent extensor rigidity |
4 |
|
Recumbent , constant extensor rigidity |
3 |
|
Recumbent , constant extensor rigidity with opisthotonos |
2 |
|
Recumbent , hypotonia of muscles , depressed or absent spinal reflexes |
1 |
Brainstem reflexes |
Normal pupillary light reflexes and oculocephalic reflexes |
6 |
|
Slow pupillary light reflexes and normal to reduced oculocephalic reflexes |
5 |
|
Bilateral unresponsive miosis with normal to reduced oculocephalic reflexes |
4 |
|
Pinpoint pupils with reduced to absent oculocephalic reflexes |
3 |
|
Unilateral , unresponsive mydriasis with reduced to absent oculocephalic reflexes |
2 |
|
Bilateral , unresponsive mydriasis with reduced to absent oculocephalic reflexes |
1 |
Level of consciousness |
Occasional periods of alertness and responsive to environment |
6 |
|
Depression or delirium , capable of responding but response may be inappropriate |
5 |
|
Semi-comatose , responsive to visual stimuli |
4 |
|
Semi-comatose , responsive to auditory stimuli |
3 |
|
Semi-comatose , responsive only to repeated noxious stimuli |
2 |
|
Comatose , unresponsive to repeated noxious stimuli |
1 |
Neurological assessment can be complicated by the administration of antiepileptic drugs . This patient had been given multiple doses of diazepam and a loading dose of phenobarbital , which can cause respiratory and neurological depression [ 26 , 27 ] . This may increase the patient ' s dependence on supplementary oxygen and put it at risk of further aspiration due to loss of pharyngeal tone [ 31 ] . The absence of a gag reflex may indicate that endotracheal intubation should be considered to protect the airway from further instances of aspiration and subsequent worsening of the patient ' s condition .
The patient presented with hyperglycaemia and hyperlactataemia . Hyperglycaemia is commonly caused by seizure activity . It is associated with higher mortality rates in patients as it increases inflammation and has negative effects on cardiovascular and coagulatory function [ 32 ] . Hyperlactataemia can also be caused by seizures ; the increased oxygen demand of the muscles leads to hypoxaemia and subsequent anaerobic metabolism [ 33 ] . The patient ' s blood glucose and lactate should be rechecked at regular intervals to ensure they are improving as expected [ 27 ] .
The patient was also hyperthermic on presentation , so cooling measures were implemented . Hyperthermia is a common complication of seizures , resulting from increased muscle activity [ 26 ] . Additionally , brachycephalic patients are at increased risk of hyperthermia as they have a limited ability to dissipate heat due to their nasal stenosis and shortened skull , resulting in reduced airflow and a smaller surface area for evaporation .
Hyperthermia increases tissue oxygen consumption , which can worsen existing hypoxaemia [ 34 ] . Severe hyperthermia with a body temperature of over 41 ° C can result in organ damage , including cerebral oedema , which can lead to seizures .
The patient ' s temperature should be closely monitored , especially if seizure activity recurs . If the patient ' s temperature increases above 40 ° C , passive cooling methods should be implemented ; these can include administering cool IV fluids , using ice packs wrapped in towels , and placing fans in front of the kennel [ 35 ] . The patient must be closely monitored , as cooling must be discontinued when its temperature reaches 39.5 ° C , to avoid rebound hypothermia [ 14 ] .
36 Veterinary Nursing Journal