Coma is an acute, life-threatening condition of unresponsiveness or a prolonged loss of consciousness. Coma implies dysfunction of cerebral hemispheres, medulla and brain stem structures. This article will let you know what happens in coma, types, and causes of coma and recovery time.
Coma can be of two basic types – Traumatic and Non Traumatic. Causes for non-traumatic coma are mentioned below
Head injury, stroke, drugs and toxin-induced and infections are some of the common causes of coma. In people above 40 years of age, stroke and metabolic causes such as diabetes, electrolyte imbalance and organ failure are seen commonly.
Often the mode of onset of coma indicates a probable diagnosis. Coma due to head injury is rather spontaneous as compared to coma from hypoglycemia which is more gradual.
Glasgow Coma Scale, however, is of limited use in pediatric patients of up to 36 months of age.
Glasgow Coma Scale (GCS) | ||
Behavior | Response | Score |
Eye-Opening | Spontaneous To verbal commands To pain No response | 4 3 2 1 |
Verbal Response | Oriented to time, place and person Confused but answers questions Inappropriate words Incomprehensible sounds No response | 5 4 3 2 1 |
Motor Response | Obeys commands The purposeful movement to a painful stimulus Withdraws in response to pain Abnormal flexion (decorticate posture) Abnormal extension (decerebrate position) No response | 6 5 4 3 2 1 |
Total Score | Fully alert and conscious Comatose Deep comatose or unresponsive
| 15 8 or less 3 |
Glasgow Coma Scale – Pupil Reactivity Score (GCS-PRS) | ||
Pupils not reacting to light | Score | |
Both pupils One pupil Neither pupil | 3 2 1 |
Rancho Los Amigos Scale | ||
Levels
| Response | Assistance needed |
Level 1 | No response | Total assistance |
Level 2 | Generalized reflex response to pain | Total assistance |
Level 3 | Localized response – Blinks to strong light, turns away/towards the sound, responds to physical discomfort, inconsistent response to verbal commands. | Total assistance |
Level 4 | Confused/ Agitated – Alert but extremely short attention span. Performs non-purposeful motor activities. | Maximal assistance |
Level 5 | Confused/ Non-agitated – Complete attention towards surrounding environment, distractible. Inappropriate speech. | Maximal assistance |
Level 6 | Confused/ Appropriate – Inconsistent orientation to time, place and person. Follows simple directions consistently. | Moderate assistance |
Level 7 | Automatic/ Appropriate – Patient performs a daily routine with minimal confusion but in a robotic manner. Skills noticeably deteriorated. | Minimal assistance |
Level 8 | Purposeful/ Appropriate – Patient responds appropriately to the environment and has a functioning memory | Stand-by assistance |
Coma can last for several days or weeks. There have also been cases reported where coma lasted for several months and even years (maximum duration being 42 years).
Following treatment, patients can recover from coma, retain a vegetative state or die. The vegetative state can also last for several months or years. Similarly, a person in a deep coma doesn’t necessarily have slim chances of recovering; such patients can eventually recover completely.
Dr. Himanshi is a Homoeopathic consultant and currently working as a lecturer in Post-graduate faculty of Homeopathy, Parul University, Vadodara. Completed BHMS and MD in Homeopathy in January 2018 and also has a clinical experience of about 6 years. Personal interests include reading, spending time with family and traveling.
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