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20. Perusal of the said MLC Ex.PW5/A would show that the injured Nafisa Begum had been admitted into the BJRM Hospital on 8.5.07 at 3.00p.m by HC Jadu Boro. And after her medical examination it was found, at that time the patient was drowsy but was responding to painful stimuli, there was a history of loss of consciousness (LOC), both ears bleeding, nasal bleeding was also present. However, no history of vomiting or convulsion was found and pupils of both eyes were semi dilated and were sluggish in reaction and the Glasgow coma scale score of the injured Nafisa Begum has been mentioned as E3V4M5=12/5.

Glasgow Coma Scale or GCS, is a neurological scale which aims to give a reliable, objective way of recording the conscious state of a person, for initial as well as subsequent assessment. A patient is assessed against the criteria of the scale, and the resulting points give a patient score between 3(indicating deep unconsciousness) and either 14(original scale) or 15 (the more widely used modified or revised scale).

GCS was initially used to assess level of consciousness after head injury, and the scale is now used by first aid, EMS and doctors as being applicable to all acute medical and trauma patients. In hospitals it is also used in monitoring chronic patients in intensive care.

 Elements of the scale

                            Glasgow Coma Scale

            1           2               3              4              5    6
Eyes     Does not Opens eyes in Opens eyes in Opens eyes        N/A       N/A
         open     response to   response to   spontaneously
         eyes     painful       voice
                  stimuli
Verbal Makes      Incomprehen Utters         Confused           Oriented, N/A
       no         sible sounds inappropriate disoriented        converses
       sounds                  words                            normally
Motor Makes       Extension to    Abnormal       Flexion/Withdra Localizes Obe
      no          painful         flexion to     wal to painful  painful   ys
      move-       stimuli(decer   painful        stimuli         stimuli   com
      ments       ebrate          stimuli                                  man
                  response)       (decerebrate                             ds.
                                  response)

The scale comprises three tests: eye, verbal and motor responses. The three values separately as well as their sum are considered. The lowest possible GCS(the sum) is 3(deep coma or death), while the highest is 15(fully awake person) Individual elements as well as the sum of the score are important. Hence, the score is expressed in the form :

"GCS 9=E2V4M3 at 0.7:35"

Generally, brain injury is classified as:

Severe, with GCS<8 Moderate, GCS 9 - 12 Minor, GCS>13.

21. From the aforesaid literature which has been downloaded from the Internet from Wikipedia, the free encyclopedia, the Glasgow Coma Scale score of Nafisa Begum, which has been mentioned on the MLC is 12/15, the same in relation to the brain injury in view of the criteria laid down above, can be classified as moderate, as the same falls within the range 9-12.