Coma: Types, Causes, Risk, and Treatments

What Is a Coma?

A coma is an interruption in brain activity that blocks consciousness. This means you are unconscious, unaware of your surroundings, and unable to wake. Comas vary in severity and can occur due to a variety of diseases. Some causes of coma can be treated or reversed. Comas are medical emergencies that require immediate care.

What Are the Types of Coma?

The types of coma include natural and induced coma. Let us see about them in brief -

Induced Coma -

• It is a type of temporary coma induced medically to protect your brain from swelling after severe injury or trauma, and give your body time to heal.

• You will be given a controlled dose of anesthesia under medical supervision, resulting in loss of sensation or consciousness.

• Your doctor will continuously monitor your vitals.

Natural Coma -

• It is a deep state of unconsciousness.

• It occurs due to decreased oxygen supply to the brain, trauma or head injuries that cause bleeding and swelling of the brain, or a stroke, where blood flow is blocked to a significant part of the brain.

What Are the Causes of Coma?

Here is a list of reasons that might cause a coma -

• Hypoglycemia (extremely low blood sugar).

• Hyperglycemia (very high blood sugar).

• Alcohol poisoning.

• Seizures.

• Head injuries.

• Lack of blood supply to the brain.

• Lack of oxygen to the brain.

• Certain infections, like meningitis, may cause swelling of the brain or the surrounding tissues, leading to coma.

• Exposure to heavy metals, carbon monoxide, or certain herbicides.

• Illnesses that impact or result in liver or kidney failure.

• Abnormalities in electrolytes, such as hypercalcemia (high calcium) or hyponatremia (extremely low sodium).

• Hypothermia (extremely low body temperature).

• Hyperthermia (extremely high body temperature).

• Increased pressure inside the brain.

What Are the Ten Stages of a Coma?

Doctors commonly use the Ranchos Scale to evaluate a patient's improvement as they awake from a coma. The updated version of the Ranchos Scale includes ten stages of a coma. However, initially, the original Ranchos Scale had eight stages. The updated version is now in use. They are as follows -

• Stage 1 - There is no response to any stimulation.

• Stage 2 - There is a response, but it will either be the same for all stimuli or a different response for the same stimuli.

• Stage 3 - The individual can reply to friends and relatives, and the responses are a little more consistent.

• Stage 4 - The person is confused or anxious.

• Stage 5 - They are still anxious, but they can follow basic instructions.

• Stage 6 - There is still some confusion; it is not as severe, and they can reliably follow basic directions.

• Stage 7 - The person can carry out their pre-coma activities, but they may occasionally still be confused. Much less assistance is required.

• Stage 8 - They can now perform various activities and are no longer confused.

• Stage 9 - They are a lot more self-sufficient now, but they cannot always predict issues.

• Stage 10 - The individual may now make decisions and manage themselves almost entirely on their own.

What Are the Risk Factors of Coma?

The risk factors of coma include the following -

• Head injuries.

• Stroke (occurs when the blood supply to the brain is reduced).

• Diabetes (high blood sugars).

• Bleeding within and around the brain.

• Seizures.

• Low blood pressure.

• Low thyroid function.

• Irregular heart rhythms.

• Failure to use protective gear.

How to Diagnose a Coma?

A neurological examination plays a vital role in diagnosing a coma. After this examination, your doctor can assess the severity of the coma using a tool such as the Glasgow Coma Scale. It is essential to identify the cause of the coma as soon as possible, including identifying any underlying medical issues. Along with the neurological examination, your doctor will use other tests to determine the cause and the extent of the coma.

Some tests that help detect the cause or severity of the coma include -

• Blood Tests: This includes a complete blood count, blood sugar level, thyroid function, kidney function, and liver function tests. This helps to detect any underlying health condition.

• Urine Analysis: This can help the doctor determine whether the individual has any infections or toxins that could have caused the coma.

• Spinal Tap or Lumbar Puncture: To identify any infection, your doctor may take a sample from the spine and send it to a laboratory for screening.

• Imaging: Imaging studies like computed tomography and magnetic resonance imaging will help detect any changes in your brain structure or damage to the brain.

• Electroencephalogram: This test helps to identify your brain’s electrical activity and the severity of coma. It also helps to recognize signs of various conditions, such as seizures that may cause coma.

• Electrocardiogram: This test evaluates how well your heart functions and helps detect diseases that could cause a coma.

How to Treat a Coma?

Individuals in a coma require emergency treatment, and the treatment varies depending on the cause. The treatment approach that works for one cause may exacerbate the condition for another. So, different strategies are used for different patients. Some forms of therapy to manage coma include -

• In some cases, a procedure or medication to reduce brain swelling may be necessary.

• Sometimes, emergency personnel may administer antibiotics or glucose via an arm vein. In cases of extremely low blood sugar or a brain infection, these may be given even before the results of blood tests are known.

• If the cause of the coma is a medication or an illegal drug overdose, the doctor will give suitable medications to treat the cause.

• Medicines are administered to treat seizures if they are the cause of coma.

• Additional therapies or drugs may be used to treat underlying conditions like diabetes or liver disease.

Sometimes a coma's cause can be totally reversed, and the individual who was affected can function normally again. Usually, healing happens gradually. In some situations, severe brain damage may cause a person to never regain consciousness or have lasting disability.

Apart from these treatments, individuals in a coma require supportive measures as well. It includes the following -

• Nutrition: Even if individuals are in a coma, they require proper nutrition and sufficient fluids. This implies the use of feeding or gastric tubes to provide liquid nutrients directly to the stomach. Initially, the tube will be inserted via the nose; later, it can be surgically inserted into the stomach via the abdomen.

• Skin Health: Since they cannot move, they are at high risk of developing bed sores or pressure injuries. To avoid this, they must be turned from one side to the back and then to the other side at regular intervals, and should be properly cleaned and dried after bowel movements.

• Bowel and Bladder Health: Individuals in a coma will not be able to control their bowel and bladder. So usually urinary catheters will help drain the urine from the bladder, and adult briefs will help with bowel movements.

• Muscle and Joint Health: Muscle and joint tightness occur when muscles constrict and joints become stiff. To avoid this, regular range-of-motion exercise that moves the limbs with natural movements should be performed.

What Are the Chances of Recovery and Prognosis for a Coma?

It is challenging to determine when a person will regain consciousness when in a coma. It varies between individuals, so it is better to discuss this with the treating doctor. The longer the person is in a coma, the poorer the prognosis.

How will you know that your loved one is recovering from a coma? Signs of coming out of a coma: If a person is awakening from a coma, then you will notice them -

• Opening their eyes.

• Initiating to move.

• Responding to pain stimuli or touch, and

• Trying to turn themselves in bed.

• Also, they will try to cough or remove medical tools like breathing tubes or IV (intravenous) lines.

Conclusion:

A coma is a condition where you will not be aware of your surroundings or will not be conscious. Individuals in a coma require emergency treatment to prevent severe complications, and the treatment depends on the cause of the coma.

Get expert advice from a neurologist if someone you know is in a coma, and find proper guidance for a speedy recovery.

Key Takeaway From iCliniq:

• A coma is a state of unconsciousness for a prolonged time due to a disruption in brain activity.

• Traumatic brain injury is a primary cause of coma around the world, accounting for almost 50 percent of all cases.

• If you are concerned about the prognosis of a loved one in a coma, book a neurologist consultation at iCliniq; our doctors can walk you through the treatment procedure and explain it further.