Comas & Traumatic Brain Injury
A coma is defined as a profound or deep state of unconsciousness. When a coma lasts longer than 4 weeks it is a more serious loss of consciousness and it’s reclassified as a persistent vegetative state.
There are many medical complications that can cause a patient to fall into a coma. Here are some common causes:
- Traumatic brain injury
- Diabetes (hypoglycemic coma)
- Lack of oxygen
- Hemorrhage
- Swelling
- Infection
- Stroke
- Toxic exposure
Traumatic brain injuries are the most common causes of comas, most of which were caused by automobile accidents or assaults. Traumatic brain injuries may be classified as either open head injuries or closed head injuries. Both can cause focal brain damage, which affects isolated sections of the brain, or diffuse brain damage, which affects a broader area. Focal and diffuse brain damage can influence consciousness, as well as cause intracranial pressure or swelling.
Common Symptoms of Comas:
One of the most obvious symptoms of a coma is a lack of consciousness. Patients who suffer from mild traumatic brain injuries may experience headaches, drowsiness, confusion, body aches, fever and dizziness before falling into a coma.
Patients in a coma lack awareness and wakefulness, which means they do not respond to external stimuli or pain. Although they may demonstrate reflexive movements, patients who do not exhibit purposeful movements are deemed unconscious. Comatose patients also keep their eyes closed, have impaired breathing and fail to exhibit a normal sleep-wake pattern.
Children sometimes have different responses to comas. They show delayed recovery of consciousness in response to the psychological stresses of being in the hospital, rather than continued biological causes
.
Studies show that patients remaining in a vegetative state for at least one year after injury are unlikely to gain consciousness, although they may live for many, many years.
Patients over 40 years of age have a poorer rate of recovery than younger patients, post coma.
Absence of eye opening in the first thirty days after injury is indicative of a poor prognosis.
90% of brain injured patients who are vegetative for one month or longer will fail to improve to a state better than severe disability. However, two thirds of patients who were unconsciousness for two weeks or less may make a moderate to good recovery.
Coma Complications
Patients in a coma are at risk for a variety of complications. One of the most serious is progression into a persistent vegetative state. A coma lasting longer than two to four weeks is reclassified as a persistent vegetative state. Patients who fall into a persistent vegetative state typically have much lower chances of recovery.
Doctors always monitor comatose patients for any secondary brain injuries caused by brain swelling or intracranial pressure.
Due to inactivity, patients in a coma may experience bed sores, or skeletal or muscular atrophy. These complications can be overcome with appropriate rehabilitation plans.
Coma Treatment
In order to successfully treat comatose patients, doctors must prevent secondary brain injuries from causing further damage, such as swelling and intracranial pressure.
Reducing Intracranial Pressure
To reduce intracranial pressure, doctors can prescribe medication or recommend surgery. A craniotomy may be performed to relieve pressure; this procedure creates holes in the skull to allow for excess blood and fluid to drain. Alternatively, the surgeon may insert a catheter to relieve pressure or remove a portion of the skull to create room for brain swelling.
Other Coma Treatments
Upon admission to a hospital, patients often receive antibiotics or glucose to treat suspected infections or diabetic comas. Doctors may also administer strong medications to control patients who suffer from non-convulsive seizures.
Because there is no cure for a coma, treatment options are limited to preventing further damage, treating underlying causes and maintaining proper blood flow and nutrition.
Coma Prognosis
When a patient suffers a mild head injury they can often regain consciousness within a few weeks. They usually regain their cognitive and motor skills with the help of rehabilitation. They have a better chance of recovering the skills necessary to live independently than a patient who has suffered severe head trauma.
If a patient suffers severe head trauma, they may slip into a persistent vegetative state. Patients who fall into a persistent vegetative state typically have much lower chances of recovery.