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PostSubject: Coma   Coma EmptyThu Jan 20, 2011 9:20 pm

Coma
Filed under: Amazing Mind
Coma is a state of prolonged unconsciousness that can be caused by a
variety of problems — traumatic head injury, stroke, brain tumor, drug
or alcohol intoxication, or even an underlying illness, such as diabetes
or an infection.

Coma is a medical emergency. Swift action is needed to preserve life and
brain function. Doctors typically order a battery of blood tests and a
brain CT scan to try to determine what's causing coma so that proper
treatment can begin.

Comas seldom last longer than several weeks. People who are unconscious
for longer than that can transition to a persistent vegetative state.
Depending on the cause of coma, people who are in a persistent
vegetative state for more than three years are extremely unlikely to
awaken.

©1998-2011 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.
Expand Arrow DownSymptoms

The signs and symptoms of coma commonly include:

* Closed eyes
* Depressed brainstem reflexes, such as pupils not responding to light
* No responses of limbs except for reflex movements
* No response to painful stimuli, except for reflex movements
* Irregular breathing

When to see a doctor
Coma is a medical emergency. Seek immediate medical care.

©1998-2011 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.
Expand Arrow DownCauses

Many types of problems can cause coma. Some examples are:

* Traumatic brain injuries. Brain injuries that result from traffic
collisions or acts of violence are the most common cause of comas.
* Stroke. Acute loss of blood flow to the brain followed by swelling
or no blood flow to a major part of the brainstem can result in coma.
* Diabetes. Blood sugar levels that get too high (hyperglycemia) and
stay too high or get too low (hypoglycemia) and stay too low can cause
coma.
* Lack of oxygen. People who have been rescued from drowning or been
resuscitated after a heart attack may not awaken due to lack of blood
flow and oxygen to the brain.
* Infections. Encephalitis and meningitis are infections that cause
inflammation of the brain, spinal cord or the tissues that surround the
brain. Severe cases of either of these infections can result in coma.
* Seizures. Ongoing seizures may lead to coma.
* Toxins. Exposure to toxins, such as carbon monoxide or drug overdoses, can cause brain damage and coma.
* Intoxication. Overdosing on drugs, medication or alcohol can result in coma.

©1998-2011 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.
Expand Arrow DownComplications

Although many people gradually recover from coma, others enter a vegetative state or die.

Complications that may develop during coma include pressure sores, bladder infections and pneumonia.

©1998-2011 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.
Expand Arrow DownPreparing for your appointment

Coma is an emergency medical condition. If you are with a person who
develops signs and symptoms of coma, call 911 or your local emergency
number immediately.

When you arrive at the hospital, emergency room staff will urgently need
as much information as possible about what happened before the coma. On
the way to the hospital, try to pull together answers to the following
questions:

* Did the coma start abruptly or gradually?
* Were there problems with vision, dizziness or numbness beforehand?
* Does the affected person have any history of diabetes, seizures or strokes?
* Did you notice any changes in the person's health in the time
leading up to the coma, such as a fever or worsening headache?
* Did you notice any changes in the person's ability to function in
the time leading up to the coma, such as frequent falls or confusion?
* What prescription or nonprescription drugs did the affected person use?

©1998-2011 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.
Expand Arrow DownTests and diagnosis

Because people in coma can't express themselves, doctors must rely on
physical clues and information provided by families and friends. Be
prepared to answer a number of questions about:

* What happened leading up to the coma
* The affected person's medical history, including other diagnoses
* Recent changes in the affected person's health or behavior
* The affected person's drug use, including prescription and
over-the-counter medications as well as illegal, recreational drugs

Physical exam
Doctors will check your reflexes, response to painful stimuli and pupil
size. Squirting ice cold or warm water into the ear canals also can be
informative. In unconscious people, these tests will cause reflexive eye
movements of different types, depending on the cause of
unconsciousness.

Laboratory tests
Blood samples will be taken to check for:

* Complete blood count
* Electrolytes, glucose and liver function
* Carbon monoxide poisoning
* Drug overdose

A spinal tap (lumbar puncture) can check for signs of infections. During
a lumbar puncture procedure, a doctor inserts a needle into your spinal
canal, measures the pressure and collects fluid for analysis. The
entire procedure usually takes about 10 minutes.

Brain scans
Imaging tests help doctors pinpoint areas of brain injury. Tests may include:

* CT. A CT scan uses a sophisticated X-ray machine linked to a
computer to produce detailed images of your brain. This is the best
imaging test for assessing brain injuries because it can show a
hemorrhage or brain tissue swelling. The scan takes only a few minutes.
* MRI. This scan uses a magnetic field and radio waves to generate
images of the brain. You lie inside a cylindrical machine for 15 minutes
to an hour. MRI scans are particularly useful for examining the
brainstem and deep brain structures. Sometimes a dye is injected into
your bloodstream during the procedure. The dye can help distinguish
damaged brain tissue from healthy tissue.
* Electroencephalography (EEG). An EEG measures the electrical
activity inside the brain. Small electrodes are attached to the scalp
with paste or an elastic cap. The electrodes pick up the brain's
electrical impulses, which are recorded on the EEG machine. This test
can determine if you're having nonconvulsive seizures, which can cause
comas.

©1998-2011 Mayo Foundation for Medical Education and Research (MFMER). Terms of use.
Read this article on Mayoclinic.com.
Expand Arrow DownTreatments and drugs

Coma is a medical emergency, and attention first is given to maintaining
respiration and circulation. Assistance with breathing, administration
of fluids and blood, and other supportive care may be necessary.

Emergency personnel may administer glucose or antibiotics intravenously,
even before blood test results return, on the chance that the person is
in diabetic shock or has an infection affecting the brain.

Treatment varies, depending on what's causing the coma. Sometimes
surgery is needed to relieve the pressure due to brain swelling. Other
treatments may focus on addressing an underlying disease, such as
diabetes, kidney failure or liver disease.

Sometimes the cause of coma can be completely reversed and the person
will regain normal function. But if the brain damage is severe, the
person may sustain permanent disabilities or may never regain
consciousness.

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