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| Coma Coma is a state of profound unconsciousness in which the patient is incapable of conscious behavior. It can be said that coma is a state wherein there is very little brain activity, and the patient hovers between life and death. Coma implies dysfunction of the cerebral hemespheres, the upper brain stem, or both areas. In other words, damage to the brain's "thinking, and life support centers" are thought to cause the coma. In such injuries you see bleeding into the brain, swelling and congestion of damaged tissue, and to a lesser degree invaision of infectious organizms. Each of which cause brain tissue to die off, this is known as secondary damage. In extreme cases the swelling is so extensive that portions of the brain are forcibly squeezed outside of the skull. The dead and dying tissue is then surgicaly removed. In other cases the skull is sawed off and placed in cold storage to better accommodate the swollen brain. TBI Glossary There are two principle types of coma associated with head and spinal trauma. The first type results from cerebral contusion, lacerations, and edema. Often, they are accompanied by severe head injuries, and by fractures of the skull. Respiration is labored due to pulmonary congestion, or chest wounds. Hemiplegia, decorticate rigidity (arms flexed and adducted; legs and often trunk extended, or decerebrate rigidity (jaws clenched, neck retracted, all limbs extended) is common. Lumbar puncture reveals bloody Cerebrospinal Fluid, CSF accompanied by elevated blood pressure (intracranial pressure), coupled with a slowing pulse and respiration. The second type of coma is caused by damage to the brainstem. Signs include coma. laborious breathing, pinpoint pupils, quadrispasticity with arms flexed and trunk and legs extended, but without intracranial pressure (elevated blood pressure). Such cases almost always imply severe brain damage and carry a poor prognosis. Since severe head injuries are often accompanied by thoracic damage, pulmonary edema (some of which is undoubtedly neurogenic), hypoxia, and an unstable circulation often complicate the neurologic problems created by the injury. Damage to the cervical spine also a common accompaniment, can cause fatal respiratory paralysis or permanent quadriplegia from cord injury; other cord damage can be almost as disastrous. Complications: Acute subdural or intracerebral hematomas are common in severe head injury and, together with severe brain edema, are present in most fatal cases. All three conditions cause signs of progressive rostral-caudal neurologic deterioration in the form of : deepening coma, widening pulse, dilated pupils, spastic heimplegia with hyperreflexia, quadrispasticity, pupillary fixation to light, decorticate rigidity, decerebrate rigidity. (See: TBI Glossary) Coma has two principle stages and many intermediary stages.
During the first stage of coma patients are incapable of voluntary activities such as eye
opening, and speech. In some cases primitive avoidance responses, such as gag reflex,
response to noxious stimuli, and responce to pain might be absent. In the second stage of
coma, they open their eyes, but they don't do anything. They don't follow commands. They
don't speak. They don't interact with their loved ones, this is called a vegitative state.
About 5% to 10% of all coma patients are incapable of conscious behavior, and end
up vegetative, which most of the public think of as prolonged coma. So, when the patient
opens his or her eyes, he or she is no longer in coma, but s/he's not doing anything. So,
s/he's just aroused, which means s/he's in a vegetative state. Even today, with all of our
impressive medical advances, there remain more questions than answers regarding coma.
Scientists used to think that all the damage to the brain occurred at the moment of
impact. But now, they know that a lot of the damage actually occurs afterwards, in the
first week in the hospital. The brain swells up, which compromises its ability to get
enough blood and oxygen, and then, parts of the brain die. That damage in itself can be
far worse than the first injury. At the moment of impact, the patient's brain is violently
thrusted back and forth inside the skull, tearing blood vessels and pulling nerve fibers.
These injuries cause the brain to swell, blocking the flow of oxygen-carrying blood. Such
a condition could result in massive strokes and/or brain death. There's this period of
time which can last from a few days to a week -- It can even last up to months -- where
there's no conscious behavior. The most common cause of death and disability in
young people in the age of one to 44 is head injury. In other words, every ten minutes
head injury claims the life of yet another child. The brain is one of the most complicated
organs of the body, subject to much study and misunderstanding.
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Diagnose - Coma Index Page - Minor Head Injury - Traumatic Head Injury |
