Coma

Diagnosis

When a person is in a coma, they cannot communicate, so healthcare professionals rely on physical signs and information from family members or friends. Providing detailed background information is essential to help identify the cause. This may include:

• Events before the coma, such as vomiting or headaches.

• How the loss of consciousness occurred — suddenly or gradually.

• Any symptoms noted beforehand.

• Medical history, including past conditions like strokes or ministrokes.

• Recent changes in health, behavior, or personality.

• Use of prescription drugs, over-the-counter medicines, or illicit substances.

Physical Exam

During the physical examination, healthcare professionals typically:

• Check movements, reflexes, and pupil reactions.

• Observe breathing patterns for clues to the cause of coma.

• Inspect the skin for signs of trauma or bruising.

• Apply pain or sound stimuli and observe reactions, such as eye movement or vocal responses.

• Test reflexive eye movements to identify possible brain damage.

• Introduce cold or warm water into the ear canal and watch for involuntary eye responses.

Laboratory Tests

Blood and other samples are analyzed to detect potential causes, such as:

• Complete blood count.

• Blood sugar and electrolyte levels.

• Thyroid, kidney, and liver function tests.

• Carbon monoxide poisoning.

• Drug or alcohol overdose.

A spinal tap, also known as a lumbar puncture, may be performed to check for infections in the nervous system. This involves inserting a needle into the spinal canal to collect cerebrospinal fluid for testing.

Brain Scans

Imaging tests help identify injuries or abnormalities in the brain. Common scans include:

• CT scan: Uses X-rays to create detailed brain images and detect bleeding, tumors, or strokes. It’s often the first test done in suspected coma cases.

• MRI: Uses magnetic fields and radio waves to provide detailed images of brain structures, particularly useful for detecting brainstem or deep-tissue damage.

• EEG (Electroencephalogram): Measures brain electrical activity through electrodes placed on the scalp to detect seizures or abnormal brain patterns.

Treatment

A coma is a medical emergency that requires immediate care. The first step is to secure the person’s airway and ensure proper breathing and circulation. They may need:

• Breathing support, intravenous (IV) medications, and continuous monitoring.

• Emergency glucose or antibiotics if low blood sugar or brain infection is suspected.

• Treatments to relieve brain swelling or pressure if necessary.

The exact treatment depends on the cause:

• Medicine or toxin overdose may be treated with antidotes.

• Seizure-related comas are managed with anticonvulsant medications.

• Underlying diseases like diabetes or liver disorders are treated with targeted therapy.

Some people recover fully if the cause is reversible. However, in severe cases of brain injury, recovery may be partial or not occur at all.

Preparing for Your Appointment

Coma is a life-threatening emergency. Call emergency medical services immediately if someone becomes unresponsive.

When you arrive at the hospital, be prepared to provide as much information as possible to the medical team. Questions they may ask include:

• Did the coma develop suddenly or gradually?

• Were there symptoms like dizziness, weakness, or vision problems before it happened?

• Does the person have diabetes, seizures, or a history of stroke?

• Did the person mention recent illness, fever, or headache?

• Were there changes in mood, memory, or coordination before the coma?

• Has the person used prescription or nonprescription drugs recently?