Materiały źródłowe

• #1 Coma: What It Is, Causes, Diagnosis, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/6007-coma-persistent-vegetative-state

  A coma is a disruption in brain activity. It prevents consciousness, meaning you’re unconscious, unaware of the world around you and impossible to wake. Comas are medical emergencies and need immediate care. […] A coma is a medical emergency. If you’re with someone who’s unconscious and unresponsive, call 911 (or your local emergency services number) immediately. Many causes of coma need immediate medical care, and any delay could lead to dangerous complications or death. […] Finding the reason for the coma including diagnosing an underlying medical condition needs to happen quickly. One of the first steps to diagnosing a coma is a neurological exam. A healthcare provider can carry out this exam and then use a tool like the Glasgow Coma Scale to determine the severity of the coma. […] The treatment for a coma depends greatly on the underlying cause. Because comas can happen for so many reasons, there are many possible treatments. What works for one cause may not work for another (or might make another condition worse). […] A vegetative state is similar to a coma but isn’t the same. People in a vegetative state have recovered enough that they aren’t in a coma, but their brain’s abilities and activity are still very limited.

• #2 Coma: Causes, diagnosis, treatment, and outlook

  https://www.medicalnewstoday.com/articles/173655

  A coma can result from complications of conditions such as diabetes or an infection, or from a traumatic incident involving a blow to the head or a lack of oxygen. […] A coma is state of deep unconsciousness. It is similar to a deep sleep, but the person cannot wake up or respond in the usual way to their environment. Their levels of consciousness and responsiveness will depend on how much the brain functions. […] A coma can last from a few days to a few weeks. The outcome will depend on the cause and any brain damage that has occurred. […] If a person enters a coma following a medical or traumatic event, it is a medical emergency. Doctors may need to take rapid action to preserve their life and brain function. […] A coma is a deep state of unconsciousness. The outcome of a coma depends on the cause and severity of the damage a person has sustained or the diagnosed condition.

• #3 Coma: Causes, diagnosis, treatment, and outlook

  https://www.medicalnewstoday.com/articles/173655

  A coma can result from complications of conditions such as diabetes or an infection, or from a traumatic incident involving a blow to the head or a lack of oxygen. […] A coma is state of deep unconsciousness. It is similar to a deep sleep, but the person cannot wake up or respond in the usual way to their environment. Their levels of consciousness and responsiveness will depend on how much the brain functions. […] A coma can last from a few days to a few weeks. The outcome will depend on the cause and any brain damage that has occurred. […] If a person enters a coma following a medical or traumatic event, it is a medical emergency. Doctors may need to take rapid action to preserve their life and brain function. […] A coma is a deep state of unconsciousness. The outcome of a coma depends on the cause and severity of the damage a person has sustained or the diagnosed condition.

• #4 Coma – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430722/

  The first goal of the clinician is to stabilize the comatose patient and diagnose and treat any reversible causes of coma such as hypoglycemia. Further evaluation follows that will identify a likely cause of coma or do the initial critical sorting into structural or nonstructural causes of coma. […] Coma represents brain failure. It may be caused by neuronal dysfunction from many causes including structural or nonstructural processes affecting the central nervous system. […] Metabolic or infectious etiologies may diffusely affect the brain and lead to a coma. Common toxic or metabolic causes of coma include hypoglycemia, hyperglycemia, excessive alcohol intake, and medication overdose or illicit drug use. […] Structural brain diseases such as subdural or epidural traumatic hematomas, spontaneous intracranial hemorrhages, venous thrombosis, tumors, acute hydrocephalus, raised intracranial pressure, anoxic brain injury, or brainstem strokes may all cause altered mental status or coma.

• #5 Coma – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430722/

  The first goal of the clinician is to stabilize the comatose patient and diagnose and treat any reversible causes of coma such as hypoglycemia. Further evaluation follows that will identify a likely cause of coma or do the initial critical sorting into structural or nonstructural causes of coma. […] Coma represents brain failure. It may be caused by neuronal dysfunction from many causes including structural or nonstructural processes affecting the central nervous system. […] Metabolic or infectious etiologies may diffusely affect the brain and lead to a coma. Common toxic or metabolic causes of coma include hypoglycemia, hyperglycemia, excessive alcohol intake, and medication overdose or illicit drug use. […] Structural brain diseases such as subdural or epidural traumatic hematomas, spontaneous intracranial hemorrhages, venous thrombosis, tumors, acute hydrocephalus, raised intracranial pressure, anoxic brain injury, or brainstem strokes may all cause altered mental status or coma.

• #6 Coma – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/coma/diagnosis-treatment/drc-20371103

  Because people in comas can’t express themselves, healthcare professionals must rely on physical clues and information provided by family members and friends. […] The exam is likely to include: Checking the affected person’s movements and reflexes, response to painful stimuli, and pupil size. […] Blood samples typically are taken to check for: Complete blood count. […] Imaging tests help pinpoint areas of brain injury. Tests might include: CT scan. This uses a series of X-rays to create a detailed image of the brain. A CT scan can show bleeding in the brain, tumors, strokes and other conditions. This test is often used to diagnose and determine the cause of a coma. […] A coma is a medical emergency. Healthcare professionals typically first check the affected person’s airway and help maintain breathing and circulation. A person in a coma might need breathing assistance, medicines through a vein and other supportive care.

• #7 Coma – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/coma/diagnosis-treatment/drc-20371103

  Because people in comas can’t express themselves, healthcare professionals must rely on physical clues and information provided by family members and friends. […] The exam is likely to include: Checking the affected person’s movements and reflexes, response to painful stimuli, and pupil size. […] Blood samples typically are taken to check for: Complete blood count. […] Imaging tests help pinpoint areas of brain injury. Tests might include: CT scan. This uses a series of X-rays to create a detailed image of the brain. A CT scan can show bleeding in the brain, tumors, strokes and other conditions. This test is often used to diagnose and determine the cause of a coma. […] A coma is a medical emergency. Healthcare professionals typically first check the affected person’s airway and help maintain breathing and circulation. A person in a coma might need breathing assistance, medicines through a vein and other supportive care.

• #8 Coma Diagnosis | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/brain-and-nerves/coma/diagnosis.html

  The depth of the coma is usually measured in the emergency and intensive care settings using a Glascow coma scale. The scale (from 3 to 15) assesses eye opening, verbal response, and motor response. A high score indicates a greater amount of consciousness and awareness. […] In rehabilitation settings, another measurement scale is often used to indicate a patient’s level of response and ability to function. It is called a Rancho scale and is named for the rehabilitation hospital where it was created, Rancho Los Amigos, in California. […] Rancho scales are based on how the patient reacts to external stimuli and the environment. The scales consist of eight different levels and each patient will progress through the levels with starts and stops, progress and plateaus. A brief summary of the components of the Rancho scale include the following:

• #9 Glasgow Coma Scale (GCS): What It Is, Interpretation & Chart

  https://my.clevelandclinic.org/health/diagnostics/24848-glasgow-coma-scale-gcs

  The Glasgow Coma Scale is a tool that healthcare providers use to measure decreases in consciousness. Its the most widely used tool for measuring comas and decreases in consciousness. […] The Glasgow Coma Scale helps medical providers determine how conscious (or how deeply in a coma) you are based on eye, speech and movement responses. […] Experts at the University of Glasgow in Scotland developed the GCS in 1974. […] Its the most commonly used scale for measuring decreases in consciousness, including coma. […] Healthcare providers can use the GCS as part of a neurological exam. Its also useful for any situation where you might have a decrease in how conscious you are. […] The Glasgow Coma Scale has three categories that apply to a neurological exam. […] One of the best uses of the GCS is to track changes in your level of consciousness.

• #10 Glasgow Coma Scale (GCS): What It Is, Interpretation & Chart

  https://my.clevelandclinic.org/health/diagnostics/24848-glasgow-coma-scale-gcs

  A GCS score of 3 and a pupil score of 2 is a GCS-P score of 1. That means a very deep coma and no pupil reaction in both eyes. […] Generally, having a score of 8 or fewer means youre in a coma. The lower the score, the deeper the coma is. […] The Glasgow Coma Scale is the most common tool healthcare providers use to measure decreases in consciousness and comas.

• #11 Coma: Causes, diagnosis, treatment, and outlook

  https://www.medicalnewstoday.com/articles/173655

  Sometimes, a doctor will induce a coma using medications. For example, they might do this to protect the person from intense pain during a healing process or to preserve higher brain function following a form of brain trauma. […] As a person in a coma cannot communicate, the diagnosis relies on outward signs. […] A medical history alongside various tests can help determine the cause of a coma, which informs the treatment decisions. […] An overall score of 8 or less indicates a coma. The condition is moderate if the overall score is 9-12. If the overall score is 13 or more, the impairment to consciousness is minor. […] A coma is usually a serious medical emergency. Healthcare professionals will start by ensuring the immediate survival of the individual. They will secure their breathing and circulation to maximize the amount of oxygen that reaches the brain. […] If doctors can successfully treat the cause of the coma, the person may eventually awaken with no permanent damage.

• #12 Coma Diagnosis | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/brain-and-nerves/coma/diagnosis.html

  The depth of the coma is usually measured in the emergency and intensive care settings using a Glascow coma scale. The scale (from 3 to 15) assesses eye opening, verbal response, and motor response. A high score indicates a greater amount of consciousness and awareness. […] In rehabilitation settings, another measurement scale is often used to indicate a patient’s level of response and ability to function. It is called a Rancho scale and is named for the rehabilitation hospital where it was created, Rancho Los Amigos, in California. […] Rancho scales are based on how the patient reacts to external stimuli and the environment. The scales consist of eight different levels and each patient will progress through the levels with starts and stops, progress and plateaus. A brief summary of the components of the Rancho scale include the following:

• #13 Coma Diagnosis | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/brain-and-nerves/coma/diagnosis.html

  The depth of the coma is usually measured in the emergency and intensive care settings using a Glascow coma scale. The scale (from 3 to 15) assesses eye opening, verbal response, and motor response. A high score indicates a greater amount of consciousness and awareness. […] In rehabilitation settings, another measurement scale is often used to indicate a patient’s level of response and ability to function. It is called a Rancho scale and is named for the rehabilitation hospital where it was created, Rancho Los Amigos, in California. […] Rancho scales are based on how the patient reacts to external stimuli and the environment. The scales consist of eight different levels and each patient will progress through the levels with starts and stops, progress and plateaus. A brief summary of the components of the Rancho scale include the following:

• #14 Coma: What It Is, Causes, Diagnosis, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/6007-coma-persistent-vegetative-state

  A coma is a disruption in brain activity. It prevents consciousness, meaning you’re unconscious, unaware of the world around you and impossible to wake. Comas are medical emergencies and need immediate care. […] A coma is a medical emergency. If you’re with someone who’s unconscious and unresponsive, call 911 (or your local emergency services number) immediately. Many causes of coma need immediate medical care, and any delay could lead to dangerous complications or death. […] Finding the reason for the coma including diagnosing an underlying medical condition needs to happen quickly. One of the first steps to diagnosing a coma is a neurological exam. A healthcare provider can carry out this exam and then use a tool like the Glasgow Coma Scale to determine the severity of the coma. […] The treatment for a coma depends greatly on the underlying cause. Because comas can happen for so many reasons, there are many possible treatments. What works for one cause may not work for another (or might make another condition worse). […] A vegetative state is similar to a coma but isn’t the same. People in a vegetative state have recovered enough that they aren’t in a coma, but their brain’s abilities and activity are still very limited.

• #15 Coma – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/coma/diagnosis-treatment/drc-20371103

  Because people in comas can’t express themselves, healthcare professionals must rely on physical clues and information provided by family members and friends. […] The exam is likely to include: Checking the affected person’s movements and reflexes, response to painful stimuli, and pupil size. […] Blood samples typically are taken to check for: Complete blood count. […] Imaging tests help pinpoint areas of brain injury. Tests might include: CT scan. This uses a series of X-rays to create a detailed image of the brain. A CT scan can show bleeding in the brain, tumors, strokes and other conditions. This test is often used to diagnose and determine the cause of a coma. […] A coma is a medical emergency. Healthcare professionals typically first check the affected person’s airway and help maintain breathing and circulation. A person in a coma might need breathing assistance, medicines through a vein and other supportive care.

• #16 Coma : Causes, Types and Diagnosis – Apollo Hospitals

  https://www.apollohospitals.com/diseases-and-conditions/coma-causes-types-and-diagnosis

  Coma is a term people know of or hear from movies and news. But most individuals may be unsure of the causes, diagnostic methods, and treatments available. This blog addresses all factors surrounding coma, its causes, and treatment options. […] An extended period of unconsciousness is called a coma. A person in the coma is unaware of the surroundings and appears asleep. Unlike deep sleep, coma patients cannot be woken up by any provocation, including pain. […] For diagnosis of coma, a medical practitioner will need the help of the friends and relatives of the patient. They can help with any incidents or symptoms that may have contributed to the patients impairment of awareness. In addition, the healthcare provider will inquire about the persons recent changes in life, medical background, and usage of prescription, over-the-counter, and recreational medications. […] Blood checks, urine checks, and brain imaging tests like MRI, CT scans, and EEG may be conducted to finalise the treatment methodology for coma patients.

• #17 Coma: Types, Causes, Treatment, Recovery, and Outlook

  https://www.verywellhealth.com/coma-8644695

  A coma is a state of deep unconsciousness in which a person is unresponsive for a prolonged time. […] A coma may last for days or longer before a person regains consciousness, but in some situations, a person may never recover from a coma. […] The outcome of a coma depends on the severity and cause. Often, the medical cause is treated while a person is receiving respiratory and other support. […] A coma can involve one or more of these physical changes. […] When a person is diagnosed with a coma, healthcare providers work to identify the cause. Often, treatment involves medical stabilization to minimize the risk of permanent brain damage. […] Diagnosis is based on: Medical history, Physical tests, Urine test, Blood tests, Electroencephalogram (EEG), Lumbar puncture or spinal tap, Imaging scans of the brain, Electrocardiogram (EKG), Other imaging tests.

• #18 Coma – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/coma/diagnosis-treatment/drc-20371103

  Because people in comas can’t express themselves, healthcare professionals must rely on physical clues and information provided by family members and friends. […] The exam is likely to include: Checking the affected person’s movements and reflexes, response to painful stimuli, and pupil size. […] Blood samples typically are taken to check for: Complete blood count. […] Imaging tests help pinpoint areas of brain injury. Tests might include: CT scan. This uses a series of X-rays to create a detailed image of the brain. A CT scan can show bleeding in the brain, tumors, strokes and other conditions. This test is often used to diagnose and determine the cause of a coma. […] A coma is a medical emergency. Healthcare professionals typically first check the affected person’s airway and help maintain breathing and circulation. A person in a coma might need breathing assistance, medicines through a vein and other supportive care.

• #19 Coma – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/coma/diagnosis-treatment/drc-20371103

  Because people in comas can’t express themselves, healthcare professionals must rely on physical clues and information provided by family members and friends. […] The exam is likely to include: Checking the affected person’s movements and reflexes, response to painful stimuli, and pupil size. […] Blood samples typically are taken to check for: Complete blood count. […] Imaging tests help pinpoint areas of brain injury. Tests might include: CT scan. This uses a series of X-rays to create a detailed image of the brain. A CT scan can show bleeding in the brain, tumors, strokes and other conditions. This test is often used to diagnose and determine the cause of a coma. […] A coma is a medical emergency. Healthcare professionals typically first check the affected person’s airway and help maintain breathing and circulation. A person in a coma might need breathing assistance, medicines through a vein and other supportive care.

• #20 Diagnosis of Coma | Anesthesia Key

  https://aneskey.com/diagnosis-of-coma/

  Coma is by definition a medical emergency, because it impairs the patients ability to protect the airway; many underlying causes of coma are also independently emergent. […] Treatment of coma is targeted toward immediate stabilization, identification in particular of reversible underlying etiologies, and correcting alterations in normal physiologic processes. […] This article contains a differential diagnosis for coma etiologies, prioritized by acuity and reversibility, along with suggested diagnostic and stabilization strategies. […] All patients presenting with coma should undergo an emergent head computed tomography (CT) scan to exclude space-occupying structural lesions and hydrocephalus; this is especially true for those with focal neurologic deficits, such as cranial nerve findings.

• #21 The types, symptoms, and diagnosis of coma: An Overview | Medanta

  https://www.medanta.org/patient-education-blog/coma

  A coma is a medical emergency. Life and brain function must be preserved with immediate action. In order to identify the coma’s underlying cause and start the appropriate course of treatment, doctors typically run a battery of blood tests and a brain scan. […] When a patient is experiencing loss of consciousness, a medical professional will conduct a thorough examination of their body, inquiring about recent life changes, medical history, and drug use. The examination may involve checking reflexes, muscle tone, blood pressure, heart rhythm, breathing patterns, and pupil size, as well as assessing the person’s sensitivity to unpleasant stimuli. […] To evaluate the severity of the symptoms, the clinician may use a scale like the Glasgow Coma Scale to track changes over time and determine whether the patient’s level of consciousness is improving, stabilizing, or declining. In addition, several tests may be performed, including urinalysis, blood count, thyroid and liver function, electrolyte levels, blood sugar levels, carbon monoxide poisoning, drug overdose, alcohol overdose, and tests for viruses that affect the neurological system.

• #22 EEG in connection with coma | Tidsskrift for Den norske legeforening

  https://tidsskriftet.no/en/2013/01/eeg-connection-coma

  Coma is a dynamic condition that may have various causes. Important changes may take place rapidly, often with implications for treatment. The purpose of this article is to provide a brief overview of EEG patterns for comas with various causes, and indicate how EEG can contribute to an assessment of the prognosis for coma patients. […] EEG reveals immediate changes in coma, and can provide early information on cause and prognosis. It is the only diagnostic tool for detecting non-convulsive epileptic status. Locked-in syndrome may be overlooked without EEG. Repeated EEG recordings increase diagnostic certainty and make it possible to monitor coma developments. […] EEG reflects brain function continuously and therefore holds a key place in the assessment and treatment of coma. […] The overview is based on the authors extensive clinical and research-related experience of EEG in comatose patients and a discretionary selection of relevant articles on EEG in connection with coma.

• #23 EEG in connection with coma | Tidsskrift for Den norske legeforening

  https://tidsskriftet.no/en/2013/01/eeg-connection-coma

  When coma lasts for hours or days, metabolic changes take place with corresponding changes in the EEG picture. Repeated EEG examinations may be useful, partly for evaluating a prognosis, partly because epileptic activity that requires treatment may occur along the way. […] Nonconvulsive status epilepticus exists when the EEG shows persistent epileptic activity without the comatose patient presenting motoric symptoms. The diagnosis is used when the phenomenon is seen in a patient with epilepsy who has entered a protracted state of reduced consciousness or confusion. […] EEG can provide early information about the cause of and prognosis in coma states. Repeated EEG recordings increase the diagnostic reliability and make it possible to follow developments in the coma, partly in order to assess a prognosis, partly because epileptic activity requiring treatment may occur along the way. The risk of developing nonconvulsive status epilepticus is relatively high in comas irrespective of cause. This stresses the importance of EEG for comatose patients. […] EEG has a place in these assessments, not least because it requires limited resources, can be repeated without restrictions and reflects functional changes in the brain.

• #24 Coma: Types, Causes, Treatment, Recovery, and Outlook

  https://www.verywellhealth.com/coma-8644695

  A coma is a state of deep unconsciousness in which a person is unresponsive for a prolonged time. […] A coma may last for days or longer before a person regains consciousness, but in some situations, a person may never recover from a coma. […] The outcome of a coma depends on the severity and cause. Often, the medical cause is treated while a person is receiving respiratory and other support. […] A coma can involve one or more of these physical changes. […] When a person is diagnosed with a coma, healthcare providers work to identify the cause. Often, treatment involves medical stabilization to minimize the risk of permanent brain damage. […] Diagnosis is based on: Medical history, Physical tests, Urine test, Blood tests, Electroencephalogram (EEG), Lumbar puncture or spinal tap, Imaging scans of the brain, Electrocardiogram (EKG), Other imaging tests.

• #25 Diagnosis of Coma – PubMed

  https://pubmed.ncbi.nlm.nih.gov/33218655/

  The differential diagnosis for the comatose patient is includes structural abnormality, seizure, encephalitis, metabolic derangements, and toxicologic etiologies. […] Identifying and treating the underlying pathology in a timely manner is critical for the patient’s outcome. […] We provide a structured approach to taking a history and performing a physical examination for this patient population. […] We discuss diagnostic testing and treatment methodologies for each of the common causes of coma. […] Our current understanding of the mechanisms of coma is insufficient to accurately predict the patient’s clinical trajectory and more work needs to be done to investigate potential treatments for this often fatal disorder.

• #26 Diagnosis of Coma | Anesthesia Key

  https://aneskey.com/diagnosis-of-coma/

  The differential diagnosis for the comatose patient is includes structural abnormality, seizure, encephalitis, metabolic derangements, and toxicologic etiologies. Identifying and treating the underlying pathology in a timely manner is critical for the patients outcome. […] We discuss diagnostic testing and treatment methodologies for each of the common causes of coma. Our current understanding of the mechanisms of coma is insufficient to accurately predict the patients clinical trajectory and more work needs to be done to investigate potential treatments for this often fatal disorder. […] Coma may be defined as a state of prolonged unresponsive unconsciousness. As such, it is not a disease process, but rather a symptom that may be caused by a variety of disease processes. […] The common pathway resulting in coma is thought to include disruption of neuronal function or pathways from the ascending reticular activating system through the thalami to the cortex.

• #27 Diagnosis of Coma – PubMed

  https://pubmed.ncbi.nlm.nih.gov/33218655/

  The differential diagnosis for the comatose patient is includes structural abnormality, seizure, encephalitis, metabolic derangements, and toxicologic etiologies. […] Identifying and treating the underlying pathology in a timely manner is critical for the patient’s outcome. […] We provide a structured approach to taking a history and performing a physical examination for this patient population. […] We discuss diagnostic testing and treatment methodologies for each of the common causes of coma. […] Our current understanding of the mechanisms of coma is insufficient to accurately predict the patient’s clinical trajectory and more work needs to be done to investigate potential treatments for this often fatal disorder.

• #28 Coma – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430722/

  The first goal of the clinician is to stabilize the comatose patient and diagnose and treat any reversible causes of coma such as hypoglycemia. Further evaluation follows that will identify a likely cause of coma or do the initial critical sorting into structural or nonstructural causes of coma. […] Coma represents brain failure. It may be caused by neuronal dysfunction from many causes including structural or nonstructural processes affecting the central nervous system. […] Metabolic or infectious etiologies may diffusely affect the brain and lead to a coma. Common toxic or metabolic causes of coma include hypoglycemia, hyperglycemia, excessive alcohol intake, and medication overdose or illicit drug use. […] Structural brain diseases such as subdural or epidural traumatic hematomas, spontaneous intracranial hemorrhages, venous thrombosis, tumors, acute hydrocephalus, raised intracranial pressure, anoxic brain injury, or brainstem strokes may all cause altered mental status or coma.

• #29 COMA | Harrison’s Manual of Medicine

  https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623397/all/COMA

  Because coma demands immediate attention, the physician must employ an organized approach. Almost all instances of coma can be traced to either widespread abnormalities of the bilateral cerebral hemispheres or to reduced activity of the reticular activating system in the brainstem. […] Diseases that cause no focal brainstem or lateralizing neurologic signs (CT scan is often normal) include intoxications, metabolic disturbances, severe systemic infections, shock from any cause, status epilepticus, hyperperfusion syndromes, severe hyperthermia, hypothermia, concussion, and acute hydrocephalus. […] Diseases that cause focal brainstem or lateralizing cerebral signs (CT scan is typically abnormal) include hemispheral hemorrhage or infarction with secondary brainstem compression, brainstem infarction due to basilar artery thrombosis or embolism, brain abscess, subdural empyema, epidural and subdural hemorrhage, brain contusion, brain tumor with surrounding edema, cerebellar and pontine hemorrhage and infarction, widespread traumatic brain injury, and metabolic coma in the setting of preexisting focal damage.

• #30 Diagnosis of Coma | Anesthesia Key

  https://aneskey.com/diagnosis-of-coma/

  The identification of a discrete space-occupying lesion will usually require specialist consultation, because classification into operative versus nonoperative lesions is beyond the scope of most emergency medicine practitioners. […] Neurovascular etiologies of coma warrant specific discussion owing to their time-sensitive and treatable nature. […] In some cases, pontine injury may cause locked-in syndrome, which can be difficult to differentiate from coma. […] Depending on local institutional practices and resources, MRI may be considered in the evaluation of structural causes of coma.

• #31 Coma – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430722/

  The first goal of the clinician is to stabilize the comatose patient and diagnose and treat any reversible causes of coma such as hypoglycemia. Further evaluation follows that will identify a likely cause of coma or do the initial critical sorting into structural or nonstructural causes of coma. […] Coma represents brain failure. It may be caused by neuronal dysfunction from many causes including structural or nonstructural processes affecting the central nervous system. […] Metabolic or infectious etiologies may diffusely affect the brain and lead to a coma. Common toxic or metabolic causes of coma include hypoglycemia, hyperglycemia, excessive alcohol intake, and medication overdose or illicit drug use. […] Structural brain diseases such as subdural or epidural traumatic hematomas, spontaneous intracranial hemorrhages, venous thrombosis, tumors, acute hydrocephalus, raised intracranial pressure, anoxic brain injury, or brainstem strokes may all cause altered mental status or coma.

• #32 COMA | Harrison’s Manual of Medicine

  https://harrisons.unboundmedicine.com/harrisons/view/Harrisons-Manual-of-Medicine/623397/all/COMA

  Because coma demands immediate attention, the physician must employ an organized approach. Almost all instances of coma can be traced to either widespread abnormalities of the bilateral cerebral hemispheres or to reduced activity of the reticular activating system in the brainstem. […] Diseases that cause no focal brainstem or lateralizing neurologic signs (CT scan is often normal) include intoxications, metabolic disturbances, severe systemic infections, shock from any cause, status epilepticus, hyperperfusion syndromes, severe hyperthermia, hypothermia, concussion, and acute hydrocephalus. […] Diseases that cause focal brainstem or lateralizing cerebral signs (CT scan is typically abnormal) include hemispheral hemorrhage or infarction with secondary brainstem compression, brainstem infarction due to basilar artery thrombosis or embolism, brain abscess, subdural empyema, epidural and subdural hemorrhage, brain contusion, brain tumor with surrounding edema, cerebellar and pontine hemorrhage and infarction, widespread traumatic brain injury, and metabolic coma in the setting of preexisting focal damage.

• #33 Acute Coma: Approach to Diagnosis and Management | RECAPEM

  https://recapem.com/acute-coma-approach-to-diagnosis-and-management/

  Evaluation of coma should be methodical. It is useful to keep a mental checklist to avoid missing important elements of differential diagnosis, examination, and testing. […] When evaluating a comatose patient, it is imperative to concentrate first on identifying diagnoses amenable to specific emergency treatments. […] Most frequent causes of emergently treatable acute coma (surprising coma survivors): Hypoglycemia (Dextrose infusion), Severe hyponatremia (Gradual serum sodium correction), CO2 narcosis (Mechanical ventilation), CO intoxication (Hyperbaric oxygen), Opiate intoxication (Naloxone), Intracranial hemorrhage (Surgical evacuation), Basilar artery occlusion (Reperfusion therapy (IV thrombolysis and/or mechanical thrombectomy), Acute hydrocephalus (Ventriculostomy), Cerebral venous thrombosis (Anticoagulation), Status epilepticus (Antiseizure drugs), Fulminant bacterial meningitis (Antibacterial drugs with CNS penetration and dexamethasone), Hypertensive encephalopathy (Gradual blood pressure reduction), Intoxications (Antidotes), Diabetic coma (Insulin), Myxoedema coma (Thyroid supplement), Uremic encephalopathy (Dialysis), Hyperammonemic encephalopathy (Lactulose, rifaximin), Sepsis (Antibiotics, hemodynamic resuscitation).

• #34 Diabetic coma | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/diabetic-coma

  The 3 types of diabetic coma include diabetic ketoacidosis coma, hyperosmolar coma and hypoglycaemic coma. […] Diabetic coma is a medical emergency and needs prompt medical treatment. […] A coma is a medical emergency. A quick diagnosis can save the persons life. The cause of a diabetic coma is diagnosed using a number of tests including: medical history, physical examination the person may be wearing an emergency bracelet identifying their medical condition, blood tests including tests for glucose and ketone levels.

• #35 Myxedema coma – UpToDate

  https://www.uptodate.com/contents/myxedema-coma

  Myxedema coma is defined as severe hypothyroidism leading to decreased mental status, hypothermia, and other symptoms related to slowing of function in multiple organs. It is a medical emergency with a high mortality rate. Fortunately, it is now a rare presentation of hypothyroidism, likely due to earlier diagnosis as a result of the widespread availability of thyroid-stimulating hormone (TSH) assays. […] Early recognition and therapy of myxedema coma are essential. Treatment should be initiated on the basis of clinical suspicion without waiting for laboratory results. Important clues to the possible presence of myxedema coma in a poorly responsive patient are the presence of a thyroidectomy scar or a history of radioiodine therapy or hypothyroidism. A history obtained from family members often reveals antecedent symptoms of thyroid dysfunction followed by progressive lethargy, stupor, and coma. […] The clinical presentation, diagnosis, and treatment of myxedema coma will be reviewed here. The diagnosis and treatment of hypothyroidism are reviewed separately.

• #36 Myxedema Coma : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/myxedema-coma/

  Myxedema coma is a critical, life-threatening decompensation of hypothyroidism requiring rapid recognition and treatment. […] Myxedema coma is often a clinical diagnosis with support by a severely elevated TSH. […] Two clinical decision tools have been developed. Rosen’s recommends the Myxedema Coma Screening Tool to aid in diagnosis and treatment decisions (specificity and sensitivity of ~80%). However, this tool requires further validation and should be used with caution. Early consultation with internal medicine, endocrinology, and/or critical care is indicated to assist in diagnosis and management. […] Patients with myxedema coma require admission, endocrinology evaluation, and, depending on severity, ICU consultation.

• #37 Glasgow Coma Scale – Brain Injury Association of America

  https://biausa.org/brain-injury/about-brain-injury/diagnosis/hospital-assessments/glasgow-coma-scale

  The treatment team will use the Glasgow Coma Scale (GCS) to evaluate a person’s level of consciousness (LOC) and the severity of brain injury by attempting to elicit body movements (M), opening of the eyes (E), and verbal responses (V). […] Clinicians use the three values separately and collectively to make medical decisions and monitor the patient’s progress. This scale is typically used very early in the treatment process. […] GCS scores range from 15 to 3. […] The Glasgow Outcome Scale (GOS) is a brief, one-item descriptive assessment utilized by the treatment team following brain injury. The GOS is helpful in determining next steps in the individual’s care, but is not useful in detecting small, gradual improvements. […] There are five possible descriptive measures in the GOS: Dead (Severe injury or death without recovery of consciousness), Vegetative (Severe damage with prolonged state of unresponsiveness and a lack of higher mental functions), Severely Disabled (Severe injury with permanent need for help with daily living), Moderately Disabled (No need for assistance in everyday life; Employment is possible but may require special equipment), Good Recovery (Light damage with minor neurological and psychological deficits).

• #38 Coma: What It Is, Causes, Diagnosis, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/6007-coma-persistent-vegetative-state

  A coma is a disruption in brain activity. It prevents consciousness, meaning you’re unconscious, unaware of the world around you and impossible to wake. Comas are medical emergencies and need immediate care. […] A coma is a medical emergency. If you’re with someone who’s unconscious and unresponsive, call 911 (or your local emergency services number) immediately. Many causes of coma need immediate medical care, and any delay could lead to dangerous complications or death. […] Finding the reason for the coma including diagnosing an underlying medical condition needs to happen quickly. One of the first steps to diagnosing a coma is a neurological exam. A healthcare provider can carry out this exam and then use a tool like the Glasgow Coma Scale to determine the severity of the coma. […] The treatment for a coma depends greatly on the underlying cause. Because comas can happen for so many reasons, there are many possible treatments. What works for one cause may not work for another (or might make another condition worse). […] A vegetative state is similar to a coma but isn’t the same. People in a vegetative state have recovered enough that they aren’t in a coma, but their brain’s abilities and activity are still very limited.

• #39 Acute Coma: Approach to Diagnosis and Management | RECAPEM

  https://recapem.com/acute-coma-approach-to-diagnosis-and-management/

  Evaluation of coma should be methodical. It is useful to keep a mental checklist to avoid missing important elements of differential diagnosis, examination, and testing. […] When evaluating a comatose patient, it is imperative to concentrate first on identifying diagnoses amenable to specific emergency treatments. […] Most frequent causes of emergently treatable acute coma (surprising coma survivors): Hypoglycemia (Dextrose infusion), Severe hyponatremia (Gradual serum sodium correction), CO2 narcosis (Mechanical ventilation), CO intoxication (Hyperbaric oxygen), Opiate intoxication (Naloxone), Intracranial hemorrhage (Surgical evacuation), Basilar artery occlusion (Reperfusion therapy (IV thrombolysis and/or mechanical thrombectomy), Acute hydrocephalus (Ventriculostomy), Cerebral venous thrombosis (Anticoagulation), Status epilepticus (Antiseizure drugs), Fulminant bacterial meningitis (Antibacterial drugs with CNS penetration and dexamethasone), Hypertensive encephalopathy (Gradual blood pressure reduction), Intoxications (Antidotes), Diabetic coma (Insulin), Myxoedema coma (Thyroid supplement), Uremic encephalopathy (Dialysis), Hyperammonemic encephalopathy (Lactulose, rifaximin), Sepsis (Antibiotics, hemodynamic resuscitation).

• #40 Coma: Etiology, diagnosis, and treatment

  https://www.mdpi.com/1648-9144/44/10/812

  Coma is the disorder of consciousness because of the damage to diffused bilateral cerebral hemisphere cortex or reticular activating system. Coma can be caused by neurogenic (head brain injury), metabolic (endogenic), and toxic (exogenic) factors. To determine the cause of metabolic and toxic coma, laboratory tests are performed; in case of neurogenic coma, the neurologic examination is essential, when five systems are evaluated: the level of consciousness (according to Glasgow Coma Scale or Full Outline of Unresponsiveness Scale), photoreaction of pupils and ophthalmoscopic examination, oculomotoric, motoric, and cardiopulmonary systems. […] For the treatment of coma, adequate oxygenation and correction of blood circulation disorders are important. The treatment of metabolic coma is guided by special schemes; antidotes often are needed in the treatment of toxic coma, and surgery helps if traumatic brain injury is present. The prognosis and outcomes of the comatose patient depend on the age and comorbid diseases of the patient, the underlying cause of coma, timely medical help and its quality, and intensive treatment and care of the patient in coma.

• #41 A practical approach to coma diagnosis in the unresponsive patient | MDedge

  https://www.mdedge.com/content/practical-approach-coma-diagnosis-unresponsive-patient

  Diagnosis of coma in the unresponsive patient can be done in a relatively short time by making key observations that will confirm disease of either the brain stem or the hemispheres, the two locations in which coma originates. […] Determining the location of the lesion is the primary goal in early assessment of the unresponsive patient. […] Examination of the patient’s eyes is the single most important step in understanding coma.

• #42 Coma | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/coma

  Coma is a medical emergency. […] A coma is a medical emergency. A quick diagnosis can be life-saving. […] Generally, the order in which medical personnel diagnose and treat for coma is: The airway, breathing, blood pressure and pulse of the person are checked. […] The pupils of the eyes can offer information about the cause of the coma. […] A variety of blood tests can check a range of important factors including red and white blood cell counts, sugar levels, salt levels, alcohol levels, and blood levels of oxygen and carbon dioxide. […] Scans of the brain, including CT and MRI, may be needed to help diagnose injuries to the brain. […] Proper diagnosis can sometimes take hours or even days. […] Treatment of coma depends on the cause and severity, but may include: Intravenous administration of glucose in the case of hypoglycaemia.

• #43 Neuro-ophthalmic Findings in Coma – EyeWiki

  https://eyewiki.org/Neuro-ophthalmic_Findings_in_Coma

  Brainstem function should also be assessed if the patient is in a coma. […] Pupillary responsiveness to light is one of the predictors of poor outcome in TBI. […] In summary, lid (ptosis), pupil (anisocoria, RAPD, poor light reaction), ocular motility (ocular bobbing, inverse/reverse bobbing, ocular dipping, ophthalmoplegia, ocular misalignment), and ophthalmoscopic (papilledema) findings may help to localize lesions and inform the differential diagnosis in patients with coma.

• #44 Acute Coma: Approach to Diagnosis and Management | RECAPEM

  https://recapem.com/acute-coma-approach-to-diagnosis-and-management/

  Coma can be caused by structural lesions or global acute physiologic derangement of brain function. […] The neurologic deficit is almost always symmetrical. […] For example, in a toxic-metabolic coma, if the patient demonstrates either spontaneous movements or reflex posturing, the movements are symmetric without evidence of hemiparesis. […] Tremor, asterixis, and multifocal myoclonus strongly suggest metabolic coma. […] The pupillary response is generally preserved. […] Patients with an intrinsic brainstem syndrome and a normal CT scan most likely have an embolus to the basilar artery; an abnormal CT scan will likely show a hemorrhage into the brainstem, traumatic brain injury to the brainstem, or a brainstem tumor or infectious mass. […] The practice of empirically administering a battery of potential antidotes to patients presenting in a coma is no longer recommended. […] The so-called coma cocktail, consisting of some combination of an opiate reversal agent such as naloxone, thiamine, and hypertonic dextrose, has more risks than benefits.

• #45 Acute Coma: Approach to Diagnosis and Management | RECAPEM

  https://recapem.com/acute-coma-approach-to-diagnosis-and-management/

  Coma can be caused by structural lesions or global acute physiologic derangement of brain function. […] The neurologic deficit is almost always symmetrical. […] For example, in a toxic-metabolic coma, if the patient demonstrates either spontaneous movements or reflex posturing, the movements are symmetric without evidence of hemiparesis. […] Tremor, asterixis, and multifocal myoclonus strongly suggest metabolic coma. […] The pupillary response is generally preserved. […] Patients with an intrinsic brainstem syndrome and a normal CT scan most likely have an embolus to the basilar artery; an abnormal CT scan will likely show a hemorrhage into the brainstem, traumatic brain injury to the brainstem, or a brainstem tumor or infectious mass. […] The practice of empirically administering a battery of potential antidotes to patients presenting in a coma is no longer recommended. […] The so-called coma cocktail, consisting of some combination of an opiate reversal agent such as naloxone, thiamine, and hypertonic dextrose, has more risks than benefits.

• #46 Acute Coma: Approach to Diagnosis and Management | RECAPEM

  https://recapem.com/acute-coma-approach-to-diagnosis-and-management/

  Coma can be caused by structural lesions or global acute physiologic derangement of brain function. […] The neurologic deficit is almost always symmetrical. […] For example, in a toxic-metabolic coma, if the patient demonstrates either spontaneous movements or reflex posturing, the movements are symmetric without evidence of hemiparesis. […] Tremor, asterixis, and multifocal myoclonus strongly suggest metabolic coma. […] The pupillary response is generally preserved. […] Patients with an intrinsic brainstem syndrome and a normal CT scan most likely have an embolus to the basilar artery; an abnormal CT scan will likely show a hemorrhage into the brainstem, traumatic brain injury to the brainstem, or a brainstem tumor or infectious mass. […] The practice of empirically administering a battery of potential antidotes to patients presenting in a coma is no longer recommended. […] The so-called coma cocktail, consisting of some combination of an opiate reversal agent such as naloxone, thiamine, and hypertonic dextrose, has more risks than benefits.

• #47 Altered mental status and coma – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/altered-mental-status-and-coma/

  Altered mental status (AMS) is an acute change in cognitive function, psychological function, and/or level of consciousness and can manifest with confusion, behavioral changes, and changes in alertness ranging from hyperalertness to somnolence or even coma. […] Coma manifests as depressed consciousness with no response to voice, pain, or other stimulation. […] Coma scores are used to assess and monitor the level of neurological dysfunction. […] Once stabilized, a full diagnostic evaluation should be performed based on the suspected underlying etiology; this may include basic laboratory studies, ECG, head imaging, and lumbar puncture. […] The goal of initial management is to identify and treat rapidly reversible and/or time-sensitive critical causes of AMS prior to a full diagnostic evaluation. […] Perform diagnostic studies based on clinical evaluation in tandem with the initial management of AMS and coma. More thorough targeted diagnostics can be obtained once the patient is stabilized.

• #48 Diagnosis of Coma | Anesthesia Key

  https://aneskey.com/diagnosis-of-coma/

  Coma is by definition a medical emergency, because it impairs the patients ability to protect the airway; many underlying causes of coma are also independently emergent. […] Treatment of coma is targeted toward immediate stabilization, identification in particular of reversible underlying etiologies, and correcting alterations in normal physiologic processes. […] This article contains a differential diagnosis for coma etiologies, prioritized by acuity and reversibility, along with suggested diagnostic and stabilization strategies. […] All patients presenting with coma should undergo an emergent head computed tomography (CT) scan to exclude space-occupying structural lesions and hydrocephalus; this is especially true for those with focal neurologic deficits, such as cranial nerve findings.

• #49 Diagnosis of Coma | Anesthesia Key

  https://aneskey.com/diagnosis-of-coma/

  The identification of a discrete space-occupying lesion will usually require specialist consultation, because classification into operative versus nonoperative lesions is beyond the scope of most emergency medicine practitioners. […] Neurovascular etiologies of coma warrant specific discussion owing to their time-sensitive and treatable nature. […] In some cases, pontine injury may cause locked-in syndrome, which can be difficult to differentiate from coma. […] Depending on local institutional practices and resources, MRI may be considered in the evaluation of structural causes of coma.

• #50 EEG in connection with coma | Tidsskrift for Den norske legeforening

  https://tidsskriftet.no/en/2013/01/eeg-connection-coma

  Coma is a dynamic condition that may have various causes. Important changes may take place rapidly, often with implications for treatment. The purpose of this article is to provide a brief overview of EEG patterns for comas with various causes, and indicate how EEG can contribute to an assessment of the prognosis for coma patients. […] EEG reveals immediate changes in coma, and can provide early information on cause and prognosis. It is the only diagnostic tool for detecting non-convulsive epileptic status. Locked-in syndrome may be overlooked without EEG. Repeated EEG recordings increase diagnostic certainty and make it possible to monitor coma developments. […] EEG reflects brain function continuously and therefore holds a key place in the assessment and treatment of coma. […] The overview is based on the authors extensive clinical and research-related experience of EEG in comatose patients and a discretionary selection of relevant articles on EEG in connection with coma.

• #51 The accuracy of initial diagnoses in coma: an observational study in 835 patients with non-traumatic disorder of consciousness | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Full Text

  https://sjtrem.biomedcentral.com/articles/10.1186/s13049-020-00822-w

  Management of patients with coma of unknown etiology (CUE) is a major challenge in most emergency departments (EDs). […] We aim to determine the accuracy and value of the initial diagnostic hypothesis in patients with CUE. […] Overall, suspected and final diagnoses matched in 62% of 835 enrolled patients. […] There was no relevant difference in diagnostic accuracy between paramedics and physicians. […] In cases of CUE, the suspected diagnosis is unreliable, regardless of different pre-hospital care providers qualifications. […] It is not an appropriate decision-making tool as it neither sufficiently predicts the final diagnosis nor detects the especially critical comatose patient. […] To avoid the risk of mistriage and unnecessarily delayed therapy, we advocate for a standardized diagnostic work-up for all CUE patients that should be triggered by the emergency symptom alone and not by any suspected diagnosis.

• #52 The accuracy of initial diagnoses in coma: an observational study in 835 patients with non-traumatic disorder of consciousness | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Full Text

  https://sjtrem.biomedcentral.com/articles/10.1186/s13049-020-00822-w

  Management of patients with coma of unknown etiology (CUE) is a major challenge in most emergency departments (EDs). […] We aim to determine the accuracy and value of the initial diagnostic hypothesis in patients with CUE. […] Overall, suspected and final diagnoses matched in 62% of 835 enrolled patients. […] There was no relevant difference in diagnostic accuracy between paramedics and physicians. […] In cases of CUE, the suspected diagnosis is unreliable, regardless of different pre-hospital care providers qualifications. […] It is not an appropriate decision-making tool as it neither sufficiently predicts the final diagnosis nor detects the especially critical comatose patient. […] To avoid the risk of mistriage and unnecessarily delayed therapy, we advocate for a standardized diagnostic work-up for all CUE patients that should be triggered by the emergency symptom alone and not by any suspected diagnosis.

• #53 The accuracy of initial diagnoses in coma: an observational study in 835 patients with non-traumatic disorder of consciousness | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Full Text

  https://sjtrem.biomedcentral.com/articles/10.1186/s13049-020-00822-w

  The primary objective of this study was to evaluate the accuracy of initial diagnoses or working hypotheses in CUE given by prehospital emergency care providers, since these often set the course of management in this high-risk group. […] We could not detect a sufficient degree of accuracy between initial diagnoses/hypotheses and final diagnoses in a large cohort of emergency patients presenting with CUE. […] The symptom CUE in itself must be considered a life-threatening emergency, regardless of initially suspected diagnoses. […] Thus, emergency work-up of CUE should not rely on any initial diagnosis, rather every comatose patient should undergo a fast and thorough standard work-up.

• #54 The accuracy of initial diagnoses in coma: an observational study in 835 patients with non-traumatic disorder of consciousness | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Full Text

  https://sjtrem.biomedcentral.com/articles/10.1186/s13049-020-00822-w

  The primary objective of this study was to evaluate the accuracy of initial diagnoses or working hypotheses in CUE given by prehospital emergency care providers, since these often set the course of management in this high-risk group. […] We could not detect a sufficient degree of accuracy between initial diagnoses/hypotheses and final diagnoses in a large cohort of emergency patients presenting with CUE. […] The symptom CUE in itself must be considered a life-threatening emergency, regardless of initially suspected diagnoses. […] Thus, emergency work-up of CUE should not rely on any initial diagnosis, rather every comatose patient should undergo a fast and thorough standard work-up.

• #55 Coma: What It Is, Causes, Diagnosis, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/6007-coma-persistent-vegetative-state

  A coma is a disruption in brain activity. It prevents consciousness, meaning you’re unconscious, unaware of the world around you and impossible to wake. Comas are medical emergencies and need immediate care. […] A coma is a medical emergency. If you’re with someone who’s unconscious and unresponsive, call 911 (or your local emergency services number) immediately. Many causes of coma need immediate medical care, and any delay could lead to dangerous complications or death. […] Finding the reason for the coma including diagnosing an underlying medical condition needs to happen quickly. One of the first steps to diagnosing a coma is a neurological exam. A healthcare provider can carry out this exam and then use a tool like the Glasgow Coma Scale to determine the severity of the coma. […] The treatment for a coma depends greatly on the underlying cause. Because comas can happen for so many reasons, there are many possible treatments. What works for one cause may not work for another (or might make another condition worse). […] A vegetative state is similar to a coma but isn’t the same. People in a vegetative state have recovered enough that they aren’t in a coma, but their brain’s abilities and activity are still very limited.

• #56 Assessment of coma – Differential diagnosis of symptoms | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/417

  Coma is the absence of consciousness. […] This state of unarousable unconsciousness includes the failure of eye opening to stimulation, a motor response no better than simple withdrawal-type movements, and a verbal response no better than simple vocalisation of non-word sounds. This presupposes that the motor pathways and systems that would allow a conscious patient to respond are intact. […] In the assessment of conscious awareness, the Coma Recovery Scale-Revised (CRS-R) is useful in grading and tracking the level of consciousness. […] Brain death must never be diagnosed without an aetiology. […] The complete loss of awareness with preserved wakefulness and wake-sleep cycles. […] The preservation of one or a very few elements of awareness: for example, behaviourally fixating or following with the eyes and reaching purposefully for an object.

• #57 Assessment of coma – Differential diagnosis of symptoms | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/417

  Coma is the absence of consciousness. […] This state of unarousable unconsciousness includes the failure of eye opening to stimulation, a motor response no better than simple withdrawal-type movements, and a verbal response no better than simple vocalisation of non-word sounds. This presupposes that the motor pathways and systems that would allow a conscious patient to respond are intact. […] In the assessment of conscious awareness, the Coma Recovery Scale-Revised (CRS-R) is useful in grading and tracking the level of consciousness. […] Brain death must never be diagnosed without an aetiology. […] The complete loss of awareness with preserved wakefulness and wake-sleep cycles. […] The preservation of one or a very few elements of awareness: for example, behaviourally fixating or following with the eyes and reaching purposefully for an object.

• #58 Diagnosis of Coma | Anesthesia Key

  https://aneskey.com/diagnosis-of-coma/

  The identification of a discrete space-occupying lesion will usually require specialist consultation, because classification into operative versus nonoperative lesions is beyond the scope of most emergency medicine practitioners. […] Neurovascular etiologies of coma warrant specific discussion owing to their time-sensitive and treatable nature. […] In some cases, pontine injury may cause locked-in syndrome, which can be difficult to differentiate from coma. […] Depending on local institutional practices and resources, MRI may be considered in the evaluation of structural causes of coma.

• #59 EEG in connection with coma | Tidsskrift for Den norske legeforening

  https://tidsskriftet.no/en/2013/01/eeg-connection-coma

  Coma is a dynamic condition that may have various causes. Important changes may take place rapidly, often with implications for treatment. The purpose of this article is to provide a brief overview of EEG patterns for comas with various causes, and indicate how EEG can contribute to an assessment of the prognosis for coma patients. […] EEG reveals immediate changes in coma, and can provide early information on cause and prognosis. It is the only diagnostic tool for detecting non-convulsive epileptic status. Locked-in syndrome may be overlooked without EEG. Repeated EEG recordings increase diagnostic certainty and make it possible to monitor coma developments. […] EEG reflects brain function continuously and therefore holds a key place in the assessment and treatment of coma. […] The overview is based on the authors extensive clinical and research-related experience of EEG in comatose patients and a discretionary selection of relevant articles on EEG in connection with coma.

• #60 Coma | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/coma

  Recovery is usually a slow process, with the person first gaining some awareness of whats going on around them and eventually being able to respond. […] Brain death means the person has such severe brain damage that they are no longer able to breathe by themselves and need to be kept on a respirator.

• #61 Assessment of coma – Differential diagnosis of symptoms | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/417

  Coma is the absence of consciousness. […] This state of unarousable unconsciousness includes the failure of eye opening to stimulation, a motor response no better than simple withdrawal-type movements, and a verbal response no better than simple vocalisation of non-word sounds. This presupposes that the motor pathways and systems that would allow a conscious patient to respond are intact. […] In the assessment of conscious awareness, the Coma Recovery Scale-Revised (CRS-R) is useful in grading and tracking the level of consciousness. […] Brain death must never be diagnosed without an aetiology. […] The complete loss of awareness with preserved wakefulness and wake-sleep cycles. […] The preservation of one or a very few elements of awareness: for example, behaviourally fixating or following with the eyes and reaching purposefully for an object.

• #62 Diagnosis of Coma – PubMed

  https://pubmed.ncbi.nlm.nih.gov/33218655/

  The differential diagnosis for the comatose patient is includes structural abnormality, seizure, encephalitis, metabolic derangements, and toxicologic etiologies. […] Identifying and treating the underlying pathology in a timely manner is critical for the patient’s outcome. […] We provide a structured approach to taking a history and performing a physical examination for this patient population. […] We discuss diagnostic testing and treatment methodologies for each of the common causes of coma. […] Our current understanding of the mechanisms of coma is insufficient to accurately predict the patient’s clinical trajectory and more work needs to be done to investigate potential treatments for this often fatal disorder.

• #63 Diagnosis of Coma | Anesthesia Key

  https://aneskey.com/diagnosis-of-coma/

  The differential diagnosis for the comatose patient is includes structural abnormality, seizure, encephalitis, metabolic derangements, and toxicologic etiologies. Identifying and treating the underlying pathology in a timely manner is critical for the patients outcome. […] We discuss diagnostic testing and treatment methodologies for each of the common causes of coma. Our current understanding of the mechanisms of coma is insufficient to accurately predict the patients clinical trajectory and more work needs to be done to investigate potential treatments for this often fatal disorder. […] Coma may be defined as a state of prolonged unresponsive unconsciousness. As such, it is not a disease process, but rather a symptom that may be caused by a variety of disease processes. […] The common pathway resulting in coma is thought to include disruption of neuronal function or pathways from the ascending reticular activating system through the thalami to the cortex.

• #64 Coma – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/coma/symptoms-causes/syc-20371099

  Coma is a medical emergency. Quick action is needed to preserve life and brain function. Healthcare professionals typically order a series of blood tests and a brain scan to try to learn what’s causing the coma so that proper treatment can begin. […] A coma is a medical emergency. Seek immediate medical care for the person in a coma. […] Many types of problems can cause a coma. Some examples are: […] The risk of coma goes up with age. This is especially true if older adults: […] Although many people gradually recover from a coma, others enter a persistent vegetative state or die. Some people who recover from a coma end up with major or minor disabilities. […] During a coma, bedsores, urinary tract infections, blood clots in the legs and other problems may develop.

• #65 Coma – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430722/

  The differential diagnosis of coma is extensive. Unless a recognizable infectious or metabolic cause of coma is promptly established, additional testing will be necessary. […] Determination of the serum glucose by the point of care testing or empiric administration of glucose is recommended for all patients with altered mental status. […] If a readily reversible cause of coma is not discovered, further evaluation is indicated. […] Patients with reversible causes of coma, such as hypoglycemia, may be discharged after the appropriate intervention and with consideration of a safe home environment. Patients with persistent coma need hospital admission with ongoing monitoring, supportive care, and targeted care to the underlying cause of coma. […] The prognosis of patients presenting with non-traumatic coma depends largely on both the etiology of coma and the level of consciousness on admission.

• #66 Myxedema Coma or Crisis: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/123577-overview

  Myxedema coma typically occurs in patients with long-lasting, previously undiagnosed hypothyroidism and is generally precipitated by infection, congestive heart failure, acute myocardial infarction, cerebrovascular accident, gastrointestinal bleeding, or medications. […] Myxedema coma occurs because of long-standing, undiagnosed or undertreated hypothyroidism. Although any of the causes of hypothyroidism can lead to myxedema coma, the most common is chronic autoimmune thyroiditis. […] Myxedema coma is a medical emergency. If the condition is not promptly diagnosed and treated, the mortality rate can be as high as 50%. Even with immediate recognition and appropriate medical intervention, mortality rates of up to 25% have been observed. […] Factors associated with poor prognosis are body temperature less than 93F (33.9C), persistent hypothermia unresponsive to 72 hours of therapy, advanced age, bradycardia ( 44 beats per minute), sepsis, myocardial infarction, and hypotension.

• #67 Glasgow Coma Scale (GCS): What It Is, Interpretation & Chart

  https://my.clevelandclinic.org/health/diagnostics/24848-glasgow-coma-scale-gcs

  The Glasgow Coma Scale is a tool that healthcare providers use to measure decreases in consciousness. Its the most widely used tool for measuring comas and decreases in consciousness. […] The Glasgow Coma Scale helps medical providers determine how conscious (or how deeply in a coma) you are based on eye, speech and movement responses. […] Experts at the University of Glasgow in Scotland developed the GCS in 1974. […] Its the most commonly used scale for measuring decreases in consciousness, including coma. […] Healthcare providers can use the GCS as part of a neurological exam. Its also useful for any situation where you might have a decrease in how conscious you are. […] The Glasgow Coma Scale has three categories that apply to a neurological exam. […] One of the best uses of the GCS is to track changes in your level of consciousness.

• #68 EEG in connection with coma | Tidsskrift for Den norske legeforening

  https://tidsskriftet.no/en/2013/01/eeg-connection-coma

  Coma is a dynamic condition that may have various causes. Important changes may take place rapidly, often with implications for treatment. The purpose of this article is to provide a brief overview of EEG patterns for comas with various causes, and indicate how EEG can contribute to an assessment of the prognosis for coma patients. […] EEG reveals immediate changes in coma, and can provide early information on cause and prognosis. It is the only diagnostic tool for detecting non-convulsive epileptic status. Locked-in syndrome may be overlooked without EEG. Repeated EEG recordings increase diagnostic certainty and make it possible to monitor coma developments. […] EEG reflects brain function continuously and therefore holds a key place in the assessment and treatment of coma. […] The overview is based on the authors extensive clinical and research-related experience of EEG in comatose patients and a discretionary selection of relevant articles on EEG in connection with coma.

• #69 Diagnosis of Coma – PubMed

  https://pubmed.ncbi.nlm.nih.gov/33218655/

  The differential diagnosis for the comatose patient is includes structural abnormality, seizure, encephalitis, metabolic derangements, and toxicologic etiologies. […] Identifying and treating the underlying pathology in a timely manner is critical for the patient’s outcome. […] We provide a structured approach to taking a history and performing a physical examination for this patient population. […] We discuss diagnostic testing and treatment methodologies for each of the common causes of coma. […] Our current understanding of the mechanisms of coma is insufficient to accurately predict the patient’s clinical trajectory and more work needs to be done to investigate potential treatments for this often fatal disorder.

• #70 Diagnosis of Coma | Anesthesia Key

  https://aneskey.com/diagnosis-of-coma/

  The differential diagnosis for the comatose patient is includes structural abnormality, seizure, encephalitis, metabolic derangements, and toxicologic etiologies. Identifying and treating the underlying pathology in a timely manner is critical for the patients outcome. […] We discuss diagnostic testing and treatment methodologies for each of the common causes of coma. Our current understanding of the mechanisms of coma is insufficient to accurately predict the patients clinical trajectory and more work needs to be done to investigate potential treatments for this often fatal disorder. […] Coma may be defined as a state of prolonged unresponsive unconsciousness. As such, it is not a disease process, but rather a symptom that may be caused by a variety of disease processes. […] The common pathway resulting in coma is thought to include disruption of neuronal function or pathways from the ascending reticular activating system through the thalami to the cortex.

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