Coma

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Signs and Symptoms

All of the various states of unconsciousness are symptoms of severe neurological dysfunction. Coma can begin suddenly, such as when a person suffers a brain hemorrhage or severe head trauma, or can develop slowly over time. In a person who is intoxicated with alcohol or

other drugs, for example, the early signs of an impending state of unconsciousness develop slowly. Usually the progression of the state of unconsciousness and how quickly it develops, provides clues about what is causing it.

In a slowly developing coma, patients may be only mildly confused and drowsy in the beginning, and/or their personality may change. If the underlying cause is an infection in the central nervous system, patients may feel a headache or other bodily discomfort, a fever, rash, muscular pains, or dizziness, before the actual coma develops. As time passes, they may begin to show signs of lethargy and obtundation, during which they are not quite unconscious but are not responding to external stimuli.

Sometimes a person who is falling into unconsciousness may not recognize what is happening and may not be able to complain. Or, it may happen so quickly that they don't have time to notice and complain.

After a person has entered into a state of unconsciousness, he or she may not respond to external stimuli, depending on how deep the coma is, and/or may show abnormal body movements. An unconscious person may lie still and not respond to anything, or may move spontaneously. These movements can include shaking, tremors, and jerking movements. The eyes may move abnormally. If the breathing muscles are affected, the patient's breathing may be irregular, and a respirator may be required.

Causes

There are many things that can cause coma or other states of unconsciousness. Some of the causes are treatable and reversible, and others are not. Some of them are focal processes—localized abnormalities that exist only in one part of the brain; others are diffuse processes that affect large parts of the brain.

Focal Processes
Focal processes that are localized to a specific spot in the brain and can lead to coma include: brain hemorrhage, an abnormal flow of blood that occurs in a specific place in the brain; ischemic stroke, a stroke due to the obstruction of a blood vessel in the brain; a brain tumor; and brain abscesses, infections in the brain.

Diffuse Processes
Diffuse processes that are widespread and affect large parts of the brain include the following:

• Head trauma associated with an increased intracranial pressure
• Various toxins, including poisons, alcohol and other drugs (e.g., barbiturates, opiate narcotics, sedatives, amphetamines, cocaine, aspirin)
• Metabolic abnormalities that lead to either elevated or reduced glucose levels in the blood
• Liver or kidney failure
• Hypoxia (poor oxygenation)
• Imbalance of electrolytes (substances like salts that are found in the blood and tissues and play essential roles in normal body function)
• Central nervous system infections (e.g., meningitis, encephalitis)
• Hemorrhage in one of the membranous layers covering the brain
• Seizure disorders
• Extreme elevation in blood pressure

Psychiatric Cause
Sometimes, it is difficult to know if a person's unresponsiveness is due to psychiatric problems rather than a medical illnesses.

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