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A coma is the most common condition in people who have suffered severe head injuries as a result of, for example, a car accident or a fall from a height. However, a coma can also appear in the course of many diseases, e.g. diabetes - then it is referred to as a diabetic coma. The exception is a pharmacological coma, into which the patient is introduced on purpose. What is a coma? How long does it take? What are its causes? How is a coma different from the often mistaken vegetative state?

What is a coma?

Comais a state of deep and long-term loss of consciousness, during which the patient cannot be awakened by any sound or sensory stimulus. Coma is most often diagnosed in people with damage to the midbrain and pons or medial hypothalamus.

Coma should not be confused with occlusion syndrome or with a vegetative state, which is one of the complications of coma. In the vegetative state, the patient is also unaware, but the reflex reactions are preserved.

It is commonly believed that a person in a coma does not feel, hear or understand. Doctors argue that this is the case only at the first moment of post-traumatic shock, but after several hours the patient receives tactile or auditory impulses, which he registers and understands. According to research by British scientists, more than 50% of people in a coma remain conscious, not just the causative power. Therefore, people in a coma should be treated gently (you cannot pinch or poke them).

How long does a coma last?

The state of deeply disturbed consciousness can last for several hours or even several dozen years. The exception ispharmacological coma , into which the patient is introduced on purpose. However, it should not last longer than 6 months.

Coma - symptoms. Glasgow Scale

Using the so-calledGlasgow scalestands outfour degrees of coma depth . The severity of the coma can be determined by observing:

  • pupillary reflexes
  • blood pressure
  • breath
  • heart rate
  • body temperature

The Glasgow scale measures eye opening (1 to 4), verbal contact (1 to 5) and motor responses (1 to 6).

During coma, the patient does not react even to very strong onesstimuli that could wake him up. In addition, a lack of reflexes is diagnosed (areflexia). The pupils are wide on both sides and do not react to light. All reflexes are suppressed, only breathing is preserved (in this state, the brain can control the heart and breathing).

Cases where it is necessary to intubate and artificially support the breath - connection to a ventilator in medical terminology is referred to ascoma exceeded .

In less deep coma states, primitive reactions to the pain stimulus may occur, the pupillary reaction is preserved, and Babinski's symptom is often present (reflex straightening of the toe with its dorsiflexion during irritation of the skin of the lateral-lower surface of the foot).

In turnsoporthissemi-coma- the patient reacts to strong pain stimuli, and when asked about something, he can answer.

Coma: causes and types

1. Central nervous system damage :

  • traumatic :
    • concussion
    • contusion of the brain
    • traumatic brain edema
    • epidural hematoma
    • subdural hematoma
    • stroke

More than 50 percent of comas are caused by head injuries. Head injuries (e.g. in an accident) can lead to bleeding and / or swelling of the brain. The swelling can put pressure on the brain stem, which can result in damage to the reticular formation and death of the patient.

  • non-traumatic :
    • inflammation of the central nervous system (meningitis and encephalitis)
    • brain tumor
    • brain abscess
    • vascular disorders (hemorrhagic stroke, ischemic stroke, venous sinus thrombosis)
    • brain hypoxia
    • abnormal sleep and wake states

2. Metabolic disorders

  • diabetes complications
    • hypoglycemia (drop in blood sugar, followed by hypoglycemic coma)
    • hyperglycemia (excess blood sugar).Hyperglycemic comacan lead to types of coma such as keto coma, lactate coma,hyperosmolar coma .
  • protein metabolism disorders -peraprotein coma
  • hypercalcemia - hyperparathyroidism causes an increase in blood calcium, which results inhypercalcemic coma
  • hypocalcemia - hypoparathyroidism lowers the level of calcium in the blood, resulting incomahypocalcemic

3. Infectious diseases

African coma(so-called African trypanosomiasis) is a tropical parasitic disease caused by parasites (Gambian trypanosomes) transmitted by various species of tsetse fly.

4. Poisoning

Overdose of sleeping pills, sedatives, drugs, alcohol. Poisoning with carbon monoxide, organic solvents, insecticides and plant protection agents.

This group also includes self-poisoning of the organism:

  • self-poisoning by nitrogen metabolic products that are normally excreted in the urine can causeuremic coma
  • ammonia self-poisoning, caused by liver failure, may causehepatic coma (hepatic encephalopathy)

5. Epilepsy

After severe convulsions, the patient may be deeply unconscious for several minutes or more.

6. Mental disorders

For example, conversion disorders (dissociative stupor).

There are many other causes of coma.

Coma can be the final stage of any serious disease that disrupts the functioning of the body.

The coma that heals

Another case ispharmacological coma , which is intentionally induced to facilitate treatment and pain relief. It is most often used in severe, life-threatening conditions - after complicated operations, serious injuries, burns, and severe multi-organ failure.

Putting the patient into a pharmacological coma is similar to anesthesia of the patient for surgery. The patient most often receives drugs from the group of barbiturates (hence the other name of pharmacological coma - barbiturate coma) and opioids, but they are administered continuously to ensure that their concentration in blood levels remained constant and at the same time sufficient. In a coma, the patient does not feel pain, which in the event of an injury protects the tissues from the adverse stress hormone released in response to pain.

Contrary to the pathological coma, thepharmacological coma can wake the patient at any time- this happens immediately after stopping the administration of drugs that were previously used by doctors to induce it .

Waking up from coma

The chances of waking up from apathological comadepend on the cause of the coma, what damage to the central nervous system has occurred, whether causal treatment can be applied, andduration of coma - the longer it lasts, the worse the prognosis. A coma is a period when there is a prolonged slowdown of all brain processes and the longer it lasts, the more damage it causes, leading to the disappearance of nerve cells.

The experience of doctors shows that patients after accidents have the greatest chance of getting out of a pathological coma (only a part of the brain is damaged, the functions of which can be taken over by the he althy part of the cerebral cortex). The most difficult to wake up are patients after flooding, poisoning, aspiration, strokes, because in these cases there was a long-lasting hypoxia of the brain.

The essence of the process of awakening from a pathological coma is as often as possible (preferably 24 hours a day) stimulating the brain and the whole body with incoming impulses. Therefore, during awakening, not only intensive rehabilitation is important, the aim of which is, among others, stimulation of the central nervous system, improvement of the circulatory and respiratory system, prevention or treatment of reduced mobility in the joints. Multisensory stimulation is also important:

  • aromatherapy - putting irritating or well-known smells under the nose
  • taste therapy - stimulating with tastes liked by the patient or spicy ones, e.g. lemon juice, grapefruit, orange, sauerkraut, in order to develop the swallowing reflex
  • music therapy
  • visual stimulations - a flashlight is lit in one eye, and then in the other
  • hydrotherapy: whirlpool massage. Specialists argue that all massages performed on people in a coma should be vibrating. This type of massage increases the amount of stimuli flowing to the brain

Research has shown that movement and stimulation increase the brain's repair processes (brain plasticity processes). There are known cases in which the increase in gray matter activity and the increase in its density was visible after only 7 days of rehabilitation.

The patient's diet is also important. In order for the brain to restore its functions, it must be nourished several times better than the brain of a he althy person. Of course, you have to take into account the patient's age and accompanying diseases, but doctors argue that an adult should consume even 4,000 kcal a day.

When waking up from a coma,stimulator implantation into the central nervous systemis also used. The pacemaker sends a "burst of electricity" to the brain every 15 minutes, thereby increasing cerebral flow and stimulation of the brain. This is to help wake you up. The first procedure of this type in Poland took place in May 2016 in Olsztyn and was carried out by specialists brought from Japan byFoundation "Akogo?" together with doctors from Poland. The effectiveness of these treatments in Japan is 60%.

Prof. Morita, who performed surgeries in Olsztyn together with Polish specialists, admitted that people who were operated on in Japan after these surgeries were able to eat and drink on their own, and made contact with the environment. The first awakening from a coma after such surgery in Poland took place on August 10, 2016. A 34-year-old patient woke up 2 weeks after pacemaker implantation.

What is life like after waking up from a coma?

Explains the neurosurgeon, prof. Wojciech Maksymowicz

Source: x-news.pl/Dzień Dobry TVN

About the authorMonika Majewska A journalist specializing in he alth issues, especially in the areas of medicine, he alth protection and he althy eating. Author of news, guides, interviews with experts and reports. Participant of the largest Polish National Medical Conference "Polish woman in Europe", organized by the "Journalists for He alth" Association, as well as specialist workshops and seminars for journalists organized by the Association.

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Neurology