Coma (patient information)

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 * Associate Editor(s)-In-Chief: Jinhui Wu, M.D.

Overview
A coma is not a specific disease. Instead, it is a deep state of unconsciousness, during which an individual is not able to respond to stimulation. Coma can be caused by underlying diseases, including stroke, head injury, seizures, brain tumors, brain infections, hypoxia, and diabetic hyperosmolar coma or hypoglycemia. The main signs of coma is loss of consciousness. Meidcal history, physical examination, neurological evaluation and head images may help find the cause of coma. Patients with coma require immediate treatment in order to avoid serious consequences. Treatments include treating the underlying diseases, maintaining a healthy physical state, preventing infections, and physical therapy. The prognosis of coma depends on the underlying causes, the severity and the site of neurological damage. Someone can recover, while some may keep in a vegetative state.

What are the symptoms of Coma?
Coma is not a disease but a condition, which can be caused by many disorders.
 * Onset time: When a patient suffers a hemorrhage stroke or severe head trauma, coma may start suddenly. While for a person with alcohol abuse or some kind of drugs, the progress of unconsciousness may be slowly.
 * Antecedent symptoms before coma, depending on the underlying disease: If the coma is caused by alcohol abuse or some kind of drugs, patients may experienced mildly confusion, drowsy or personality change in the beginning. If the underlying cause is a brain infection, patients may show signs including headache, fever, or dizziness before the actual coma develops. In some cases, coma may happen so quickly that patients or their families don't have time to notice.
 * Signs of coma
 * Loss of consciousness
 * Some spontaneously movements, including shaking, tremors, and jerking movements.
 * Eyes' abnormal movement
 * If the breathing muscles are affected, the patient may show irregular breathing.
 * No response to external stimuli

Diseases with similar symptoms are:
 * Syncope
 * Epilepsy
 * Dizziness
 * Hysteria

Who is at highest risk?

 * A hemorrhagic or ischemic stroke
 * A severe head injury
 * Seizures
 * Brain tumor
 * Brain infections
 * Hypoxia for a long time
 * Metabolic abnormalities, such as diabetic hyperosmolar coma, hypoglycemia
 * Toxins, including poisons, alcohol and other drugs (barbiturates, sedatives, amphetamines, cocaine)
 * Liver failure or kidney failure

When to seek urgent medical care?
When you find someone in coma, call 911 as soon as possible.

Diagnosis
The goal of the following tests is to identify the cause of coma.
 * Medical history, physical examination and neurological evaluation: These measurements may be very important to find the cause of coma.
 * Eye examination: It is also very useful to identify underlying problem in the brain.
 * Laboratory tests: These tests include the check of liver function, kidney function, glucose levels, thyroid function, even the presence of any toxins. The results of the various lab tests may provide clues to detect some metabolic diseases which can cause coma.
 * Imaging studies such as head CT (computerized axial tomography) and MRI (magnetic resonance imaging): These images can be used to detect the abnormalities in the brain.
 * Electroencephalography (EEG): This test can demonstrate the electrical activity in the brain and be used to rule out seizures.

Treatment options
Patients with coma require immediate treatment in order to avoid serious consequences. Treatments depend on the underlying cause.
 * Treatments on the underlying diseases, such as a emergent surgery for a hemorrhage stroke, antibiotics for brain infections, maintenance of normal glucose for diabetes, alexipharmic for toxins, dialysis for kidney failure.
 * Maintaining a healthy physical state, providing balanced nutrition.
 * Preventing infections, such as preventing pneumonia and bedsores.
 * Physical therapy may be used to prevent contractures and deformities of the bones, joints, and muscles.

Where to find medical care for Coma?
Directions to Hospitals Treating Coma

Prevention of Coma

 * Treating your brain diseases
 * For diabetes patients, maintaining glucose in a normal level
 * Avoidance of contacting with toxin

What to expect (Outlook/Prognosis)?
Some patients with coma can recover, while others may keep in a vegetative state. The prognosis depends on:
 * The underlying causes
 * The severity
 * The site of neurological damage

Possible complications

 * Patient may remain in coma for an extended period
 * Death