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Chapter: Diseases of The Brain and Nervous System(A Health Education Guide): Neuroradiology - Theimaging of The Brain

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Coma - Unconscious Tate: Causes, Treatment, General tips

Coma is derived from the Greek word meaning unconsciousness. Stupor, partial loss of consciousness, or long deep sleep, all these words signify varying state of the altered consciousness of the brain and body.

COMA – UNCONSCIOUS TATE

Coma is derived from the Greek word meaning unconsciousness. Stupor, partial loss of consciousness, or long deep sleep, all these words signify varying state of the altered consciousness of the brain and body. In medical science, Coma is defined as a state in which the brain loses its alertness and the body stops responding to any inner or external stimuli and stops experiencing even the basic necessities. If this state continues for a long period of time or till death, the patient can be termed a Coma-patient. The fear psychosis that has been created by this word is not really justified as coma is not always so dangerous, but at the same time it is not to be taken too lightly either. Coma is a disease that can occur to anybody, anywhere. It is more common now, due to high blood pressure caused by the modern day lifestyle, habits and stress, diabetes, and road accidents etc.




Causes :

1. Road Accidents: Brain Trauma: Concussion, Contusion,Hemorrhage (Subdural, Epidural)

2. Diseases related to blood circulation of the brain :

Thrombosis (clotting of blood in the vessels), Embolism, Hemorrhage, and Sub-arachnoid Hemorrhage.

3. Infections of the brain: Falciparum malaria, Meningitis,TB, Viral-Encephalitis, AIDS, and other opportunistic diseases like fungal; parasite infection, syphilis etc.

4. Brain Tumor: Cancerous tumors (primary or secondary)like Glioma or Metastasis, simple tumors like meningioma. In all these tumors, symptoms like headaches, vertigo, convulsions, vomiting, and paralysis of one or both the sides are seen. Differential diagnosis can be done on the basis of medical examination, CT scan and MRI.

5. Metabolic diseases: Diabetic coma is the commonest inthese diseases. The tense lifestyle, mental stress, busy schedule etc. play a very important role in this. Oxygen deficiency, fluctuation in the blood sugar level, liver diseases, kidney diseases, respiratory disorders etc. cause debility in various organs of the body and eventually the efficiency of the brain is affected, causing coma.

6. Nutritional deficiency or dehydration can also lead tocoma. Extreme deficiency of important elements like vitamin B1, B12 etc. can also cause coma. Decrease in sodium level can also lead to coma, which is known as Hyponatremic Coma.

7. Hormonal Imbalance: Imbalance in the hormones ofthyroid, parathyroid, adrenal, pituitary glands can also lead to coma.

8. Epilepsy: Epileptic attacks can also lead to coma.

9. Alzheimer’s Disease: during the last stage of thedisease one might lapse into coma.

10. Poison: Organophospherous poisoning or heavy metalslike arsenic or lead used for murder or suicide, overdose of sleeping pills, can also lead to coma.

11. Drug Addiction.

12. Psychogenic Coma: (the patient is not actually in coma) The treatment of coma should be done systematically. Usually, the patient is thoroughly examined and his/her history, pulse, temperature, respiration are noted. The Nervous system and the eyes are also examined along with certain specific tests of the body and brain, which include various blood tests, MRI, CT scan, E.E.G. If necessary cerebrospinal fluid is also examined. These are very helpful for the treatment. Before a coma patient is considered brain dead, the brain death has to be ascertained very carefully and the rules and regulations made specifically for this purpose are to be followed before declaring it. In this situation, the brain never regains consciousness, so such a patient can donate his/her kidney and other parts to save the life of another patient before his/her heart stops functioning.


Treatment :

The main points for the treatment of coma are as under:

       i.            According to the seriousness of the condition, the patient should be immediately given intensive treatment in an LC.U.

     ii.            Immediate treatment is initiated to normalise important functions like respiration, blood circulation, blood pressure.

  iii.            If the cause is unknown, immediate glucose, vitamin B1 and injection Nalorphine are administered as the first line of treatment:

  iv.            The cause/causes of Coma are determined quickly by blood tests and if need be E.E.G, CT scan, lumbar puncture etc. are conducted and accordingly its treatment is started as soon as possible. For instance if there is an infection in the brain, an antibiotic, or TB medicine can be administered, or if there is thrombosis, the drugs to prevent the blood from clotting are to be administered.

     v.            If there is dehydration, intravenous administration of fluids is done; if there is an acid base imbalance, an intensive treatment is given. Nutritional imbalance is corrected by giving a diet with proper calories.

  vi.            If the coma is due to the defect of any organ, its treatment is given or if the problem is due to diabetes or thyroid disorder, its immediate treatment is commenced.

vii.            Convulsions or deficiency of sodium etc. are also given immediate treatment with proper drugs.

There is a considerable difference between the two conditions leading to coma, i.e. structural and metabolic. Brain tumor, paralysis and brain hemorrhage caused by accident, are included in the structural causes, where the brain is attacked directly. Whereas in the metabolic coma, abnormality is first observed in other parts of the body rather than the brain. So the disease first starts in the body, which later affects the brain. There are about 2 to 8 % cases where the cause of the coma remains unknown.


General tips :

An unexpected, severe or continuous headache should never be taken lightly and the doctor should be consulted immediately. A paralytic patient should be admitted to the hospital without wasting any time, so that necessary treatment is started immediately after CT scan etc. are done. The growing numbers of paralytic and coma patients can be controlled only if blood pressure, diabetes, obesity etc. are treated properly, and lifestyle is improved.

The reasons for increase in number of coma patients now-a-days are abuse of tobacco, alcohol, drugs, road accidents, poisoning, and increasing cases of AIDS. The side effects of some drugs can also lead to coma, e.g. excessive dose of insulin lowers blood sugar level below the acceptable limits leading to coma.

There is no way to know, when a patient will come out of coma. It is different in each case. Interestingly, many coma patients have narrated similar extraordinary experiences during their coma. A patient can once again relapse into coma, after coming out of it.

Along with the right treatment proper nourishment and care, love and prayers can also give miraculous results. The will-power of the patient, which remains strong even in the unconscious state and the doctor’s loving care can also help the patient recover faster.

After remaining in a comatose state, for a considerable period when the patients recover, some may lose their speech or memory. Some may never come out of the coma and gradually slide towards brain death. In the cases of coma the average death rate is 10 to 20 precent.

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