D. Disability (GCS)

assess LOC using GCS

pupils

• assess equality, size, symmetry, reactivity to light

  • inequality/sluggish suggests local eye problem or lateralizing CNS lesion

  • relative afferent pupillary defect (swinging light test) – optic nerve damage

• extraocular movements and nystagmus

• fundoscopy (papilledema, hemorrhages)

• reactive pupils + decreased LOC: metabolic or structural cause

• non-reactive pupils + decreased LOC: structural cause (especially if asymmetric)