Definition

A coma is a state of deep unconsciousness that a person cannot be woken from. A person in a coma cannot react to events in the environment.

Causes

Information about your environment is normally passed from the brainstem into the rest of the brain. This feedback allows a person to be aware of and react to the environment. A coma is caused by a breakdown in this system.

Brainstem and Cerebrum

Copyright © Nucleus Medical Media, Inc.

The system may be interrupted by:

• Severe head injury—most often a result of car accidents, violence, or falls.
• Brain illness such as:
  • Brain tumor
  • Brain hemorrhage or stroke
  • Brain infection
• Lack of oxygen to the brain which may be due to:
  • Very high blood pressure
  • Very low blood pressure or shock
  • Cardiac arrest
  • Severe seizures
• Severe general illness such as:
  • Severe bodily infections
  • Severe acute liver or kidney failure
  • High carbon dioxide levels
  • Carbon monoxide poisoning
  • Toxicity from poisons, medication, alcohol, or drugs
  • Abnormal hormone levels, such as from the thyroid or adrenal gland
  • Abnormal blood chemistries, such as sodium or calcium
  • Very low or very high levels of blood sugar
  • Very low or very high body temperatures
  • Severe nutrient deficiency
  • Liver failure
  • Kidney failure
  • Inherited metabolic diseases

Risk Factors

Factors that may increase your chance of a coma include:

• Severe illness
• Diabetes
• Liver, kidney, or cardiovascular disease
• Tendency to have blood clots
• Exposure to poisonous substances, such as carbon dioxide
• Cancer and chemotherapy

Brain injury is more common in men. Age groups that are more likely to experience brain injury include 5 years or younger, 15-24 years old, and 75 years or older. Risk factors for brain injury include:

• Traveling in a vehicle at a high rate of speed or at night
• Lack of sleep
• A previous head injury

Symptoms

Symptoms of a coma include the following:

• No response to stimulus, such as:
  • Pain
  • Sound
  • Touch
  • Sight
• Spontaneous body movements, such as:
  • Jerking
  • Shaking
  • Trembling
  • Eyes opening and closing
  • Irregular breathing

Diagnosis

Since the patient cannot speak, information will need to be gathered from other sources, including friends, family members, and people who witnessed an accident if one occurred. This is important to help with diagnosis. The doctor will also need to know about the person’s medical history and any drug or alcohol use. It is important to provide honest information in order to help with treatment.

The doctor will test reflexes, listen to breathing, and examine the eyes. A physical exam will also be done, including tests of the nervous system.

The patient's bodily fluids will be tested. This can be done with:

• Blood tests
• Urine test
• Lumbar puncture

Images may be taken of the patient's bodily structures. This can be done with:

• Neck x-rays
• MRI scan
• CT scan
• SPECT or Xenon

The patient's brain activity may be tested. This can be done with:

• Electroencephalogram (EEG)
• Evoked potentials

Clinical findings of comatose patients can be rated according to the Glasgow Coma Scale (GCS). This scale assesses 3 different functions: eye opening, motor response, and verbal response. Scores can range from 15 to 3. A lower score indicates less responsiveness. Scores are interpreted as follows:

• 15-13—mild brain injury
• 12-9—moderate brain injury
• 8 or less—a severe brain injury

Treatment

A coma is a medical emergency. Any unconscious person should be taken to the emergency room right away.

Prevention

To help reduce your chance of a coma:

• Wear a seatbelt. Make sure infants and small children are securely fastened in a child safety seat.
• Children aged 12 years and under should ride in the back seat of a vehicle.
• Wear an appropriate helmet while biking, rollerblading, playing contact sports, skiing, snowboarding, and riding a motorcycle.
• Wear athletic mouth guards while playing sports.
• Do not abuse alcohol or drugs.
• If you have diabetes, see your doctor regularly and take appropriate steps to regulate your blood sugar levels.
• If you are ill or take medication, see your doctor regularly for check-ups.