Given the traumatic findings and altered neurological status of the patient, a neurosurgical consult is ordered.

Goal: allow the most rapid and accurate assessment as to whether the patient's neurologic pathology is due to a structural lesion or a metabolic derangement.

General questions that assess a patient's base neurologic status include the following:

• Verbal response - Spontaneous speech? Oriented to person and place? Following commands? Nonsensical mumbling?
• Eyes - Spontaneous opening? Gaze preference? Nystagmus?
• Pupillary response - Asymmetry? Pinpoint pupils?
• Motor/sensory response - Localize vs withdraw to stimulus? Decorticate vs decerebrate posturing? Abnormal movements?

Recalling the patient's original history and physical examination performed in the ED, note the following:

• Patient opens his eyes when addressed.
• Patient is saying words, but not in coherent phrases.
• Patient is not oriented to person and place.
• Patient withdraws when pressure is applied to his fingernail.