How Was The Person Found?

Could this be a major lack of oxygen or blood flow to the brain? How was the person found? What did the area around him or her look like? Was he or she breathing when first responders arrived? Was there a cardiac arrest, and how long did resuscitation efforts last before the person’s heartbeat and blood pressure were restored? Was there noticeable blood loss? Did the person’s condition deteriorate during transport? Could this be an overdose? What pills does the person have access to? Are there needle tracks? Is the individual a habitual drug user or drinker? Has he or she made prior suicide attempts or had a psychiatric consultation? Are there problems at work? Has anyone complained about the person’s drug or drinking habits? Could this be an infection? Was the person taking antibiotics for an infection? Was there a rapid onset of fever and headache? The possibility of a brain infection must always be considered when someone has a rapid onset of fever and headaches, acts confused, and seems to be developing a speech impediment. Cerebrospinal fluid should be examined quickly if there’s a possibility of infection. Failure to recognize an infection could have major consequences. Could this be low blood sugar or very high blood sodium from dehydration? Does the person have diabetes, or could the person have undiagnosed diabetes? If the person has diabetes, has he or she had difficulty controlling blood sugar levels and was there a recent change in medication to treat it? Could the coma be caused by a seizure? Does the individual have epilepsy? Could this be a clot in the basilar artery? Is the person known to have an irregular heart rate, atrial fibrillation or another cardiac condition? Were anticoagulation medications recently discontinued? Was his or her high blood pressure poorly controlled? Could this be due to extremely high blood pressure? Extremely high blood pressure makes blood vessels leaky, and swelling occurs in the surrounding brain tissue. Even after these questions are answered, we still may not know the cause of the coma. When imaging tests are performed on individuals in a coma, doctors will generally discuss the results of the tests with loved ones and point out any injuries that are found or areas of concern. Hypodensity often is an indicator of a stroke or edema. Very low density indicates air, which most often is associated with a penetrating injury. Sometimes, a poorly defined hypodense area may suggest an infection or a collection of pus. Hyperdensity, meanwhile, suggests bleeding or a blood clot. If an artery has an area of hyperdensity, there’s a clot in it. The condition is uncommon, but should be considered in an individual in acute coma with clinical signs pointing to it.

This Bird Has Flown

Presence of this sign generally will prompt additional diagnostic tests so that the clot can be retrieved. Brain swelling in a patient with a high blood pressure surge. Stroke in the cerebellum that caused major tightness in that compartment. Blood in the subdural space that caused a brain shift. Bleeding following a stroke that produced a mass effect. A gunshot wound through the brain that left a trace of blood and bone fragments. Bruising in the front of the brain. Sharp waves, spikes, slow waves, or a combination are visible. When they appear in a constant rhythm, they could be seizures. When it’s seen in individuals who aren’t sedated, it means that brain function is severely depressed. This happens most often in individuals after experiencing cardiac arrest that severely damaged cortex layers in the brain. Then, the goal is to identify the worst or best ones and the patterns that indicate that an individual’s seizures need to be treated immediately.

It's Not The Way

The findings may be revealing and affect treatment. In some cases, such as in individuals who are unconscious for a long time before someone finds them and gets them to the hospital, it may take a while to draw a definitive conclusion. In rare cases, the cause of a coma may remain unknown, but often it’s eventually found. It’s not uncommon for individuals experiencing coma to have more than one medical condition. How quickly treatment occurs and the extent of treatment may determine an individual’s future prognosis. These illustrations show common causes of coma associated with brain injury. And the brain may swing back to the opposite side, causing more bruising. The brainstem may be bruised as well. A subarachnoid hemorrhage results when a brain aneurysm bursts, increasing pressure inside the skull. How is coma treated? The clot is pushing on parts of the brain, which may become damaged if we don’t do something right away. Is the bleeding why he’s in a coma? We need to ask a neurosurgeon to get the clot out to create more space, and they may remove a piece of your father’s skull to make room in case his brain swells more later. After that, will he get better? We think his brain function will improve, but the recovery may be a long road with a lot of bumps along the way.

Over The Wall We Go

We’ll watch for any changes in his condition and continue to treat him as things evolve. Coma is undeniably a major medical emergency. Comatose patients need care that must be rendered quickly. Although not always the case, in many situations the faster the intervention, often the better the outcome. Faced with an individual who is comatose, physicians often don’t have the luxury of sitting back and thinking through every decision. Close relatives and family members of an individual in a coma shouldn’t be left in the dark about these decisions. They should be engaged right from the start because patients who are delirious or unconscious clearly don’t have the capacity to understand their situations. Their families are truly essential early on to give medical professionals direction about how much care to provide. This can range from using all available measures, to stopping short of performing major surgery, to doing nothing when there’s no chance of recovery.