Clinician's Name: Dr. Wingfield Dr. Hackett Dr. Lagutchik

Patient Profile

CSU Clinic Number:

Species:

Breed:

Age in Months:

Major Problem:

For each of the following 3 categories, select the one which most closely describes your patient

Motor Activity:
6Normal gait; normal spinal reflexes
5Hemiparesis, tetraparesis, or decerebrate activity
4Recumbent; intermittent extensor rigidity
3Recument; constant extensor rigidity
2Recumbent; constant extensor rigidity with opisthotonus
1Recumbent; hypotonia of muscles; depressed or absent spinal reflexes

Brain Stem Reflexes
6Normal pupillary light responses and occulocephalic reflexes
5Slow pupillary light reflexes; normal to reduced oculocephalic reflexes
4Bilateral unresponsive miosis; noram to reduced oculocephalic reflexes
3Pinpoint pupils; reduced to absent oculocephalic reflexes
2Unilateral, unresponsive mydriasis; reduced to absent oculocephalic reflexes
1Bilateral, unresponsive mydriasis; reduced to absent oculocephalic reflexes

Level of Consciousness:
6Occasional periods of alertness and responsive to the environment
5Depression or delerium; capable of responding to the environment
4Semicomatose; responsive to visual stimuli
3Semicomatose; responsive to auditory stimuli
2Semicomatose; responsive to noxious stimuli
1Comatose; unresponsive to repeated noxious stimuli

Please total the scores from the 3 sections and select this total below:

TOTAL SCORE: 18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3

Evaluation: 3 - 8 Grave
9 - 14 Poor to Guarded
15 - 18 Good

Comments:

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