sentences are fragmented, nonfluent, and nonsensical, with paraphasias and grammatical errors. Receptive speech is when the lesion involves the Wernicke area and the patient is unable to understand commands and questions, and speech is usually fluent but not contextual. Repetition and naming should be assessed as well.
TABLE 2.1 Updated Glasgow Coma Scale (GCS-40)a
TABLE 2.2 Short Blessed Test (SBT)a
optic nerve (afferent pathway) and returns to the circumferential pupillary sphincter by the parasympathetic fibers of the oculomotor nerve, CN III (efferent pathway, nerve fibers from Edinger-Westphal nucleus). Direct and indirect (to the contralateral eye) illumination causes constriction of both pupils (consensual reflex). The optic fibers that are responsible for this reflex pass ultimately to the ipsilateral and contralateral Edinger-Westphal nucleus (parasympathetic nucleus of the oculomotor nuclear complex), which projects axons to the ciliary ganglion (synapse) and then to the ciliary body (accommodation) and pupillary constrictors. Involvement of the optic nerve causes lack of response to light in the ipsilateral eye, but normal consensual response in both eyes when light is shone in the contralateral eye. Patients should be asked to fixate on a distant object to avoid myosis from accommodation. The afferent pupillary defect, or Marcus Gunn sign, is tested via the swinging flashlight test. When the light is on one eye, the pupils constrict initially and then dilate, and when the light moves to the affected eye, the initial constriction is lost, and the pupils continue to dilate. This sign most commonly signals the presence of an ipsilateral optic nerve lesion; it may also occur with homonymous visual loss related to optic tract lesions.