Coma

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Coma, Latin coma (from ancient Greek κῶμα 'deep sleep') is a complete loss of consciousness lasting for a prolonged period. In medicine, a full-blown coma is the most severe form of quantitative disturbance of consciousness in which a patient cannot be awakened even by strong external stimuli, such as repeated painful stimuli. If this state is not fully developed, it is referred to as sopor (precoma).

Coma is a symptom (sign of illness) and not a disease. In the International Classification of Diseases (ICD-10), it has therefore been classified under the heading "R" (symptoms and findings) (R40.2). Coma is an expression of a severe disturbance of cerebral function and is usually life-threatening. The further development (prognosis) of the comatose person depends on the underlying disease and medical care.

Causes

Primary brain diseases

Stroke (vascular occlusion or bleeding)

sudden event, coma predominantly with brain stem damage
Cerebral haemorrhages can lead to unconsciousness if they damage the brain stem directly or via a general increase in pressure in the skull.

Traumatic brain injury

Coma especially with brain stem damage

Meningitis / encephalitis

inflammatory disease, usually with high fever
Development of a coma, usually lasting for hours

epileptic seizure

sudden event, usually spontaneous recovery

Brain Tumor

slow development - coma mostly due to increased intracranial pressure

Metabolic disorder - metabolic coma

Sugar metabolism disorder

Hypoglycemia (low blood sugar)
Hyperglycaemia (hyperglycaemia, diabetic coma, see diabetes mellitus)

Oxygen deficiency (hypoxia, hypoxemia) or _{excess CO2} in the blood (hypercapnia)

in case of oxygen intake disorders (respiratory tract, lungs)
in case of circulatory failure (after a few seconds)

renal insufficiency (uremic coma, coma uraemicum)
Liver insufficiency (hepatic coma, coma hepaticum)
other metabolic causes (inborn errors of metabolism, etc.)
hormonal causes (hypopituitarism, adrenal insufficiency, myxedema coma, etc.)

Electrocution

Power accident

Poisonings

as an accident (accidental)
by drugs (e.g. alcohol, intoxicants)
medically desirable (sedation, anaesthesia, "artificial coma")

Coma Depth

The classification is based on clinical aspects, i.e. according to the reaction to certain stimuli. Depending on the classification used, three to four degrees are usually distinguished:

Degree - specific defense to pain, pupillary movement intact, eye movement intact when the organ of equilibrium (vestibulo-ocular reflex) is irritated.
Degree - undirected defense to pain, mass movements, external squint (divergent eyeballs).
Degree - no defence, only flight reflexes, vestibulo-ocular reflex absent, pupillary reaction weakened
Degree - no pain reaction, no pupillary reaction, failure of other protective reflexes

The Glasgow Coma Scale - which is also used as a decision-making aid, e.g. for ventilation - is well established in emergency medicine. It also covers minor disorders of consciousness.