Coma - Causes and Signs of Coma

The classification of the state of coma includes 15 degrees. But in practice, three types of coma are distinguished:

• deep coma - the patient does not respond to external stimuli, does not open his eyes and does not make sounds, does not come to his senses;
• coma (the most common type) - the patient is unconscious, but can open his eyes or make certain sounds. Attacks of decerebral rigidity are characteristic (spontaneous reaction of muscles in response to external stimulation, consisting in bending of joints, twitching of limbs);
• superficial coma - the patient is unconscious, but can open his eyes in response to a familiar voice, and can also pronounce words, can answer questions, but speech is incoherent.

Stages of coma development:

• precoma;
• coma of the 1st degree;
• coma of the 2nd degree;
• coma of the 3rd degree;
• coma of the 4th degree.

Causes

Causes that can cause the condition comas:

• head injury or trauma;
• brain infections;
• lack of hormones in the body;
• loss of electrolytes, energy substances and water by the body;
• brain damage caused by oxygen starvation;
• drug overdose, some medications;
• overheating of the body;
• severe alcohol poisoning;
• various diseases (diabetes);
• exposure to electric current;
• stroke.

Symptoms

Coma symptoms vary depending on its stage.

Precoma symptoms:

• confusion;
• moderate stupor;
• lethargy;
• drowsiness or, conversely, excitement;
• psychomatic states (in hypoglycemic coma);
• impaired coordination of movements;
• reflexes are preserved.

Grade 1 coma symptoms:

• sleep or stupor;
• pronounced stupor;
• slowed reaction, even in response to strong stimuli (including pain);
• ability to perform light movements;
• the patient can swallow liquid food or water;
• turn over independently while lying in bed;
• pupils react to light;
• strabismus is possible;
• eye movements are pendulum-like in nature;
• relaxation of skin reflexes is observed.

Symptoms of stage 2 coma:

• no contact with the patient;
• deep sleep;
• weakened response to pain;
• stupor;
• rare spontaneous movements that are uncoordinated;
• abnormal breathing;
• involuntary defecation and urination;
• reaction of the pupils to light relaxed;
• pharyngeal and corneal reflexes are preserved;
• skin reflexes are absent;
• muscular dystonia;
• pyramidal reflexes are determined.

Symptoms of grade 3 coma:

• no consciousness, corneal reflexes, reaction to pain;
• suppression of the pharyngeal reflex;
• miosis;
• pupils do not react to light;
• reduced tendon reflexes and muscle tone;
• convulsions are possible;
• involuntary defecation and urination;
• reduced arterial pressure;
• breathing is arrhythmic or depressed to rare and shallow;
• low body temperature.

Symptoms of stage 4 coma:

• hypothermia;
• complete areflexia;
• cessation of respiratory function due to suppression of the medulla oblongata;
• muscle atony;
• sharp drop in blood pressure;
• death.

Coma can develop almost instantly, within a few minutes or within a few hours.

Diagnostics

For a correct diagnosis, you must make an appointment to a neurologist. A doctor's consultation will help to exclude all conditions similar to a coma (hysteria, drug overdose, epilepsy, etc.). To make a diagnosis, a specialist analyzes the symptoms and signs of the patient's condition. The following diagnostic procedures are prescribed:

• blood test;
• extended biochemical blood test;
• urine test;
• computer tomography of the head;
• electrocardiogram;
• electroencephalogram;
• x-ray of the cervical vertebrae;
• studies of cerebrospinal fluid (sometimes).

Rarely, the symptoms of a coma can determine the cause that caused this condition: with oxygen starvation, the pupils are dilated and do not react to light, and with a stroke and overdose, the pupils will be constricted.

Treatment

Treatment is carried out in a hospital setting and depends on the causes that caused it. Emergency treatment consists of:

• use of agents that support blood circulation and respiration, stop vomiting;
• administration of insulin or glucose (in diabetic coma);
• blood purification (in uremic coma);
• surgical treatment is performed by a surgeon (in case of head and neck injuries);
• surgical intervention by a neurosurgeon (in case of hematomas of the meninges);
• anticonvulsants;
• drugs that force diuresis (in case of intoxication);
• use of an antidote (in case of overdose);
• administration of thiamine (in case of hypovitaminosis);
• intubation of the trachea;
• artificial ventilation of the lungs;
• antibacterial therapy.

Prevention

Prevention of coma consists in avoiding, if possible, the causes that cause it and in periodic examination by specialists, with the aim of early diagnosis of this condition.