A patient has a total GCS score of 9 with eye opening to pain (E2), verbal response of incomprehensible sounds (V3), and motor response of withdraws from pain (M4). Which of the following clinical descriptions is consistent with this GCS score?

• A. Eyes remain closed, makes incomprehensible sounds, exhibits abnormal extension
• B. Opens eyes spontaneously, is confused when spoken to, exhibits abnormal flexion
• C. Opens eyes in response to pain, uses inappropriate words, withdraws from pain
• D. Opens eyes in response to voice, makes incomprehensible sounds, localizes pain

Answer: (C)

Glasgow Coma Scale scores come from three domains—eye opening, verbal response, and motor response—each with its own scale, and you add them up to get the total.

Here, the components are E2, V3, and M4, which total 9. Eye opening to pain means the person does not open eyes spontaneously or to spoken prompts, but will open eyes when a painful stimulus is applied. Verbal response of incomprehensible sounds means the person makes sounds that are not words or recognizable phrases. Motor response of withdrawal from pain means the person pulls away from the painful stimulus rather than localizing it or showing abnormal posturing.

So the description that matches this exact pattern is eyes opening in response to pain, incomprehensible sounds, and withdrawal from pain. The other descriptions would imply different levels—for example, eyes opening spontaneously or to voice would change the eye component, verbal would shift to inappropriate words, and motor would shift to localizing pain or abnormal flexion/extension.