Materiały źródłowe

• #1 Coma: Glasgow Coma Scale, Causes, and Diagnosis

  https://www.medicinenet.com/coma/article.htm

  Coma occurs when the brain does not have enough nutrients. […] Coma is a state of decreased consciousness whereby a patient cannot react with the surrounding environment. Outside physical or auditory stimulation does not waken the person. […] Coma occurs when the brain does not have enough nutrients. For example, if inadequate amounts of oxygen or blood sugar (glucose) are delivered to it, the brain can „turn off.” Trauma, bleeding, or swelling of the brain can affect blood delivery, various poisons can also directly injure the brain, and brain inflammation and infection can also alter mental status and lead to coma. […] To be awake, the reticular activating system (RAS) must be functioning, as well as at least one cerebral hemisphere. […] If a person loses consciousness, either the RAS has stopped working, or both cerebral hemispheres have shut down.

• #1 Overview of Coma and Impaired Consciousness – Neurologic Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/neurologic-disorders/coma-and-impaired-consciousness/overview-of-coma-and-impaired-consciousness

  Coma or impaired consciousness may result from structural disorders, which typically cause focal damage, or nonstructural disorders, which most often cause diffuse damage. […] Causes may be structural or nonstructural (eg, toxic or metabolic disturbances). […] RAS dysfunction can result from a condition that has diffuse effects, such as toxic or metabolic disturbances (eg, hypoglycemia, hypoxia, uremia, overdose of a substance, illicit drug, or medication). […] Coma is unresponsiveness from which the patient cannot be aroused and in which the patient’s eyes remain closed. […] The mechanism for coma or impaired consciousness involves dysfunction of both cerebral hemispheres or of the reticular activating system (also known as the ascending arousal system). […] Diagnosis is clinical; identification of cause requires laboratory tests and neuroimaging.

• #1 Coma – Symptoms and causes – Mayo Clinic

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

  Coma can have a variety of causes, including traumatic head injury, stroke, brain tumor, or drug or alcohol intoxication. […] A coma may even be caused by an underlying illness, such as diabetes or an infection. […] Many types of problems can cause a coma. Some examples are: […] Traumatic brain injuries. These are often caused by traffic collisions or acts of violence. […] Stroke. Reduced or stopped blood supply to the brain, known as a stroke, can result from blocked arteries or a burst blood vessel. […] Tumors in the brain or brainstem can cause a coma. […] Blood sugar levels that become too high or too low can cause a coma. […] People who have been rescued from drowning or revived after a heart attack might not awaken due to lack of oxygen to the brain. […] Infections such as encephalitis and meningitis cause swelling of the brain, spinal cord or the tissues that surround the brain. Severe cases of these infections can result in brain damage or a coma. […] Ongoing seizures can lead to a coma. […] Exposure to toxins, such as carbon monoxide or lead, can cause brain damage and a coma. […] Overdosing on drugs or alcohol can result in a coma.

• #1 Coma – StatPearls – NCBI Bookshelf

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

  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. […] 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.

• #1 Approach to Stupor & Coma – EMCrit Project

  https://emcrit.org/ibcc/coma/

  Stupor and coma are the final common pathway for most serious neurological injuries, so the list of potential causes is endless. Below are the more common causes: […] Severe metabolic derangements: Hypoxic/anoxic brain injury. Hypercapnia (e.g., pCO2 typically over ~80-100 mm). Hypothermia or hyperthermia (e.g., temperature 28C or 40C). Hypoglycemia/hyperglycemia (glucose below ~40 mg/dL or 2.2 mM, or rapid rise over roughly ~900 mg/dL or 50 mM). Hyponatremia/hypernatremia (e.g., sudden drop below ~110 mM or sudden rise above ~160 mM). Hypercalcemia (e.g., ionized calcium above ~3.5 mM). Hypermagnesemia (e.g., 12 mg/dL, 5 mM, 10 mEq/L). Hepatic encephalopathy. Severe hyperammonemia (in absence of liver failure). Uremia. Myxedema coma. Wernicke’s encephalopathy. Adrenal crisis. Shock (especially septic shock).

• #2 Overview of Coma and Impaired Consciousness – Neurologic Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/neurologic-disorders/coma-and-impaired-consciousness/overview-of-coma-and-impaired-consciousness

  Coma or impaired consciousness may result from structural disorders, which typically cause focal damage, or nonstructural disorders, which most often cause diffuse damage. […] Causes may be structural or nonstructural (eg, toxic or metabolic disturbances). […] RAS dysfunction can result from a condition that has diffuse effects, such as toxic or metabolic disturbances (eg, hypoglycemia, hypoxia, uremia, overdose of a substance, illicit drug, or medication). […] Coma is unresponsiveness from which the patient cannot be aroused and in which the patient’s eyes remain closed. […] The mechanism for coma or impaired consciousness involves dysfunction of both cerebral hemispheres or of the reticular activating system (also known as the ascending arousal system). […] Diagnosis is clinical; identification of cause requires laboratory tests and neuroimaging.

• #2 Coma: Types, Causes, Treatments, Prognosis

  https://www.webmd.com/brain/coma-types-causes-treatments-prognosis

  A coma is caused by an injury to the brain. Brain injury can be due to increased pressure, bleeding, loss of oxygen, or buildup of toxins. The injury can be temporary and reversible. It also can be permanent. […] More than 50% of comas are related to head trauma or disturbances in the brain’s circulatory system. Problems that can lead to a coma include: […] Anoxic brain injury: This is a brain condition caused by total lack of oxygen to the brain. Lack of oxygen for a few minutes causes cell death to brain tissues. Anoxic brain injury may result from heart attack (cardiac arrest), head injury or trauma, drowning, drug overdose, or poisoning. […] Trauma: Head injuries can cause the brain to swell and/or bleed. When the brain swells as a result of trauma, the fluid pushes up against the skull. The swelling may eventually cause the brain to push down on the brain stem, which can damage the reticular activating system (RAS) a part of the brain that’s responsible for arousal and awareness.

• #2 Coma: Types, Causes, Treatments, Prognosis

  https://www.webmd.com/brain/coma-types-causes-treatments-prognosis

  Swelling: Swelling of the brain tissue can occur even without distress. Sometimes, lack of oxygen, electrolyte imbalance, or hormones can cause swelling. […] Bleeding: Bleeding in the layers of the brain may cause a coma due to swelling and compression on the injured side of the brain. This compression causes the brain to shift, causing damage to the brainstem and the RAS (mentioned above). High blood pressure, ruptured cerebral aneurysms, and tumors are nontraumatic causes of bleeding in the brain. […] Stroke: When there is no blood flow to a major part of the brain or loss of blood accompanied with swelling, a coma can occur. […] Blood sugar: In people with diabetes, a coma can occur when blood sugar levels stay very high. That’s a condition known as hyperglycemia. Hypoglycemia, or blood sugar that’s too low, can also lead to a coma. This type of coma is usually reversible once the blood sugar is corrected. However, prolonged hypoglycemia can lead to permanent brain damage and persistent coma.

• #2 Table: Common Causes of Coma or Impaired Consciousness-Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/multimedia/table/common-causes-of-coma-or-impaired-consciousness

  Hypoxia/ischemia […] Hypothyroidism […] Respiratory failure or heart failure […] Uremia […] Wernicke encephalopathy […] Infections […] Encephalitis […] Malaria […] Meningitis […] Sepsis […] Coronavirus disease 2019 (COVID-19) […] Severe acute respiratory coronavirus 2 (SARS-CoV2) […] Other infections including bacterial, viral, and parasitic […] Other disorders […] Diffuse axonal injury […] Hypertensive encephalopathy […] Hyperthermia or hypothermia […] Medications and illicit drugs […] Alcohol […] Anesthetics (eg, propofol) […] Antipsychotic medications if they cause neuroleptic malignant syndrome […] CNS stimulants (eg, cocaine) […] Opioid and related analgesics […] Sedatives […] Other CNS depressants […] Selective serotonin reuptake inhibitors if they cause release of excess serotonin (serotonin syndrome) […] Toxins […] Carbon monoxide […] CNS = central nervous system.

• #2 Coma: Types, Causes, Treatments, Prognosis

  https://www.webmd.com/brain/coma-types-causes-treatments-prognosis

  Oxygen deprivation: Oxygen is essential for brain function. Cardiac arrest causes a sudden cutoff of blood flow and oxygen to the brain, called hypoxia or anoxia. After cardiopulmonary resuscitation, survivors of cardiac arrest are often in a coma. Oxygen deprivation can also occur with drowning or choking. […] Infection: Infections of the central nervous system, such as meningitis or encephalitis, can also cause a coma. […] Toxins: Substances that are normally found in the body can accumulate to toxic levels if the body fails to dispose of them correctly. As an example, ammonia due to liver disease, carbon dioxide from a severe asthma attack, or urea from kidney failure can accumulate to toxic levels in the body. Drugs and alcohol in large quantities can also disrupt neuron functioning in the brain. […] Seizures: A single seizure rarely produces coma. But continuous seizures called status epilepticus can. Repeated seizures can prevent the brain from recovering in between seizures. This will cause prolonged unconsciousness and coma.

• #3 Coma: Glasgow Coma Scale, Causes, and Diagnosis

  https://www.medicinenet.com/coma/article.htm

  The effect of trauma on the brain is not predictable. […] Head trauma can cause different types of brain injury. […] Bleeding within the brain (intracerebral hemorrhage) may be small, but also may cause associated swelling that may cause damage to the brain and result in coma. […] Epidural hematomas are located between the skull and the tissue that covers the brain (dura mater). […] Subdural hematomas are located beneath the dura mater and occur when the bridging veins from the skull to the brain are torn. […] The more swelling, the higher the intracranial pressure, the deeper the coma. […] Just as blood takes up space within the skull and can cause coma, so may brain tumors. […] Infection and inflammation, such as encephalitis and meningitis of the brain and surrounding tissues may be associated with coma.

• #3 Approach to Stupor & Coma – EMCrit Project

  https://emcrit.org/ibcc/coma/

  Stupor and coma are the final common pathway for most serious neurological injuries, so the list of potential causes is endless. Below are the more common causes: […] Severe metabolic derangements: Hypoxic/anoxic brain injury. Hypercapnia (e.g., pCO2 typically over ~80-100 mm). Hypothermia or hyperthermia (e.g., temperature 28C or 40C). Hypoglycemia/hyperglycemia (glucose below ~40 mg/dL or 2.2 mM, or rapid rise over roughly ~900 mg/dL or 50 mM). Hyponatremia/hypernatremia (e.g., sudden drop below ~110 mM or sudden rise above ~160 mM). Hypercalcemia (e.g., ionized calcium above ~3.5 mM). Hypermagnesemia (e.g., 12 mg/dL, 5 mM, 10 mEq/L). Hepatic encephalopathy. Severe hyperammonemia (in absence of liver failure). Uremia. Myxedema coma. Wernicke’s encephalopathy. Adrenal crisis. Shock (especially septic shock).

• #3 Coma – StatPearls – NCBI Bookshelf

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

  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. Of all the nonstructural causes of coma, hypoglycemia and systemic infections likely account for the majority of patients presenting with coma. Other less common metabolic causes include hepatic encephalopathy, hyponatremia, hypernatremia, hypercalcemia, endocrine abnormalities, and many others. Primary central nervous system infections such as meningitis or encephalitis may lead to coma but are relatively uncommon though vitally important to detect.

• #4 Coma – StatPearls – NCBI Bookshelf

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

  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. […] 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.

• #4 Diabetic coma – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diabetic-coma/symptoms-causes/syc-20371475

  A diabetic coma is a life-threatening disorder that causes unconsciousness. If you have diabetes, dangerously high blood sugar (hyperglycemia) or dangerously low blood sugar (hypoglycemia) can lead to a diabetic coma. […] Blood sugar that’s either too high or too low for too long may cause the following serious health problems, all of which can lead to a diabetic coma. […] Diabetic ketoacidosis is most common in people who have type 1 diabetes. But it can also occur in people who have type 2 diabetes or gestational diabetes. […] If it isn’t treated, this can lead to life-threatening dehydration and a diabetic coma. […] In severe cases, low blood sugar (hypoglycemia) may cause you to pass out. Low blood sugar can be caused by too much insulin or not enough food. Exercising too vigorously or drinking too much alcohol can have the same effect.

• #5 Approach to Stupor & Coma – EMCrit Project

  https://emcrit.org/ibcc/coma/

  Toxicologic: Opioids. Alcohols (ethanol, methanol, ethylene glycol). Sedatives, including baclofen. Serotonin syndrome. Malignant catatonia, including neuroleptic malignant syndrome. Sympathomimetic intoxication. Salicylate poisoning. Lithium. Anticholinergics, including tricyclics. Carbon monoxide. Cefepime. […] Vascular: Intracranial hemorrhage: Subarachnoid hemorrhage (coma often due to acute hydrocephalus; may improve with external ventricular drain placement). Intracerebral hemorrhage (typically pontine). Large hemorrhage causing herniation. Ischemic stroke(s): Most commonly, basilar artery stroke. Severe multifocal infarction (e.g., due to endocarditis). Artery of Percheron occlusion involving bilateral thalami (rare). […] Infection/inflammation: Meningitis. Encephalitis: Most notably due to HSV or VZV. Autoimmune encephalitis. Brain abscess or subdural empyema that exerts mass effect. ADEM (acute disseminated encephalomyelitis). […] Seizure: Nonconvulsive status epilepticus (NCSE) […] Postictal state.

• #5 Diabetes-Related Coma: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/16628-diabetic-coma

  A diabetes-related coma is a life-threatening complication that can result from very high blood sugar (hyperglycemia) or very low blood sugar (hypoglycemia). […] Three diabetes complications can lead to a coma, including: Hyperosmolar hyperglycemic state (HHS). […] Diabetes-related ketoacidosis (DKA) is a life-threatening complication that mainly affects people with diagnosed or undiagnosed Type 1 diabetes. […] If you dont get treatment for HHS in time, it can lead to a coma. […] If you dont get treatment for DKA in time, it can lead to a coma. […] Prolonged severe hypoglycemia thats not treated in time can lead to a coma. […] Three diabetes complications can lead to a coma if you dont get proper treatment for them in time, including: Hyperosmolar hyperglycemic state (HHS). […] HHS and DKA can both cause severe dehydration, which can trigger a coma. […] A severe lack of glucose from low blood sugar can cause your brain to shut down and go into a coma.

• #6 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. It can also occur in patients who had a thyroidectomy or who underwent radioactive iodine therapy for hyperthyroidism. Rare causes of myxedema coma include secondary hypothyroidism and medications such as lithium and amiodarone. […] Given the importance of thyroid hormones in cell metabolism, long-standing hypothyroidism is associated with a reduced metabolic rate and decreased oxygen consumption, affecting all body systems. Consequently, myxedema coma can also result when a hypothyroidism-induced decrease in drug metabolism leads to overdosing of medications, including sedatives, hypnotics, and anesthetic agents.

• #7 Myxoedema Coma: Causes, Symptoms, Treatment | Doctor

  https://patient.info/doctor/myxoedema-coma

  Myxoedema coma is the extreme manifestation of (usually untreated) hypothyroidism. It is one of a relatively small number of endocrine emergencies, and it is a rare, but potentially fatal disorder. It does not necessarily involve the presence of pretibial oedema or of coma. […] Myxoedema coma can be difficult to diagnose and successfully treat. Even if promptly treated it has a high mortality rate. […] In a patient who has untreated or undertreated hypothyroidism several physiological changes take place to compensate for the lack of thyroid activity. This ability of the body to compensate for deficiency of T4 and T3 may, however, be overwhelmed – for example, by infection, drugs, other diseases or hypothermia. The resulting state is referred to as 'myxoedema coma’ despite the fact that the patient may not be comatose or display the skin changes of myxoedema (hence the alternative term 'myxoedema crisis’).

• #8 Diagnosing the Patient with Loss of Consciousness (Syncope and Coma) – Manual of Medicine

  https://manualofmedicine.com/topics/emergency-acute-medicine/diagnosing-patient-loss-of-consciousness-syncope-coma/

  Loss of consciousness may be transient (syncope) or ongoing (coma). […] Syncope is caused by a transient loss of consciousness and motor tone due to a reduction in cerebral perfusion. […] In coma, the patient remains unconscious and is unarousable. Coma can be caused by the following: […] Vascular: intracranial hemorrhage, cerebral infarction. […] Epilepsy: status epilepticus. […] Shock: anaphylaxis, sepsis, acute blood or fluid loss, cardiogenic, addisonian. […] Drugs overdose: narcotics, barbiturates, benzodiazepines. […] Alcohol: acute intoxication. […] Metabolic: hypoglycemia, hepatic encephalopathy, uremia, porphyria. […] Trauma, particularly closed head injury. […] Infection: meningitis, encephalitis, malaria. […] Respiratory: hypercapnia. […] Electrolyte: hyponatremia, hyper- or hypocalcemia. […] Endocrine: hypopituitarism, hypothyroidism.

• #9 Coma: Glasgow Coma Scale, Causes, and Diagnosis

  https://www.medicinenet.com/coma/article.htm

  The brain requires oxygen to function, and without it, the brain shuts down. […] Hypoglycemia (low blood sugar) most often occurs in people with diabetes who have given themselves too much insulin or have not taken in enough food. […] There are two sources of poisons that can affect the brain, those that we take into the body (through ingestion or inhaling), and those that the body generates and cannot dispose of in some way.

• #10 Coma due to drug intoxication | MedLink Neurology

  https://www.medlink.com/articles/coma-due-to-drug-intoxication

  Opiates. Overdose of various opiates can cause coma, and this may occur in the hospital setting, such as with unintended overdose of morphine sulfate or with recreational drug use, such as with heroin use. […] Benzodiazepines. Enhancement of GABA activity at specific cerebral sites accounts for the clinical features of benzodiazepine-induced coma to a large extent. […] Baclofen. Baclofen is a GABA-analogue that interacts with GABA-ergic spinal interneurons in low doses. […] Barbiturates. At high concentrations barbiturates dissolve in lipid membranes and interfere with ionic transfer and calcium uptake by nerve cell membrane. […] Cocaine. Cocaine is a psychostimulant and local anesthetic, which is sniffed, injected, or smoked. […] Methamphetamine overdose. This causes delirium, tachycardia, hypertensive crisis, malignant hyperthermia, cardiac arrhythmia, myoclonus, seizures, myoglobinuria, shock, coma, and death.

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

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

  Infections: Severe inflammation of part of the CNS or the tissues surrounding the brain known as encephalitis and meningitis, respectively can result in a coma. […] Toxins and drug overdose: Exposure to carbon monoxide can result in brain damage and coma, as can some drug overdoses. […] Traumatic brain injuries: Road traffic accidents, sports injuries, and violent attacks that involve a blow to the head can cause coma.

• #12 Table: Common Causes of Coma or Impaired Consciousness-Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/multimedia/table/common-causes-of-coma-or-impaired-consciousness

  Common Causes of Coma or Impaired Consciousness […] Cause […] Examples […] Focal […] Structural disorders […] Brain abscess […] Brain tumor […] Head trauma (eg, concussion, cerebral lacerations or contusions, epidural or subdural hematoma) […] Hydrocephalus (acute) […] Intraparenchymal hemorrhage […] Subarachnoid hemorrhage […] Cortex or upper brain stem infarct or hemorrhage […] Nonstructural disorders […] Seizures (eg, nonconvulsive status epilepticus) or a postictal state caused by an epileptogenic focus […] Diffuse […] Metabolic, hypoxic or ischemic, and endocrine disorders […] Diabetic ketoacidosis […] Hepatic encephalopathy […] Hypercalcemia […] Hypercapnia […] Hyperglycemia […] Hypernatremia […] Hypocalcemia (rarely) […] Hypoglycemia […] Hyponatremia

• #13 Stupor and Coma – Brain, Spinal Cord, and Nerve Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/brain-spinal-cord-and-nerve-disorders/coma-and-impaired-consciousness/stupor-and-coma

  A severe infection elsewhere in the body, such as sepsis (a bodywide infection). […] Severe or prolonged seizures. […] Inadequate blood flow to the brain, as occurs when the heart stops (cardiac arrest). […] Head injuries, such as concussion or bleeding in or around the brain. […] Disorders that increase pressure within the skull (intracranial pressure), including certain brain tumors and strokes. […] Some disorders interfere with the delivery of needed substances to the brain or with the body’s ability to use them. […] Other common causes are disorders that affect the areas of the brain that control consciousness. […] Any disorder that increases pressure within the skull (intracranial pressure) can impair consciousness. […] A large mass can push the brain against the relatively rigid structures inside the skull, damaging brain tissue.

• #14 Coma – Wikipedia

  https://en.wikipedia.org/wiki/Coma

  A coma is a deep state of prolonged unconsciousness in which a person cannot be awakened, fails to respond normally to painful stimuli, light, or sound, lacks a normal sleep-wake cycle and does not initiate voluntary actions. […] Comas can be the result of natural causes, or can be medically induced, for example, during general anesthesia. […] Many types of problems can cause a coma. Forty percent of comatose states result from drug poisoning. […] The second most common cause of coma, which makes up about 25% of cases, is lack of oxygen, generally resulting from cardiac arrest. […] Twenty percent of comatose states result from an ischemic stroke, brain hemorrhage, or brain tumor. […] Comatose cases can also result from traumatic brain injury, excessive blood loss, malnutrition, hypothermia, hyperthermia, hyperammonemia, abnormal glucose levels, and many other biological disorders.

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

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

  Heart issues: Oxygen is necessary for proper brain activity. A sudden cardiac arrest can cause an abrupt cessation of blood flow and oxygen supply to the brain. Survivors of cardiac arrest are frequently in coma after receiving cardiopulmonary resuscitation (CPR). Choking or drowning can also result in oxygen deprivation. […] Toxins: If the body cannot correctly eliminate certain substances, such as ammonia, carbon dioxide and urea, they can build up to toxic levels and cause harm. Large doses of alcohol and drugs can also impair brain neuron function. […] A coma brought on by head injuries often has a higher percentage of recovery than comas brought on by oxygen deprivation. A coma caused by drug usage can be cured with timely medical care. So, the cure is mostly dependent on the cause. […] Recovery from a coma depends upon the cause. Some can be cured with medication, therapy or surgery. At the same time, some remain in that stage life-long. Recovery of coma patients is almost unpredictable.

• #16 Coma Signs, Types, Causes, Prevention & Treatment

  https://www.emedicinehealth.com/coma/article_em.htm

  A coma is a deep state of unconsciousness in which individuals do not consciously respond to stimuli in their environment. […] Coma can result from an injury such as head trauma, an underlying illness such as an infection or tumor, or toxins that enter the body. […] Coma may result from significant traumatic injury to the head, such as from a car accident or fall. […] Causes of brain/skull hemorrhage include: High blood pressure (hypertension), Cerebral aneurysm: a weak spot in a blood vessel of the brain, Arteriovenous malformation (AVM): an abnormal cluster of blood vessels, Tumors. […] Causes of swelling of the brain include: Infections, Chemical imbalances, Traumatic injuries, Problems with the flow of cerebrospinal fluid (CSF). […] The most common causes of lack of oxygen to the brain include: Heart arrhythmias, Lung disease, including pneumonia, emphysema, or asthma, Anemia (low red blood cell count), Toxins.

• #17 Evaluation of coma – Differential diagnosis of symptoms | BMJ Best Practice US

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

  There are numerous encephalopathies due to electrolyte disturbances, disturbances in thyroid function, inborn errors of metabolism (e.g., porphyria, mitochondrial disorders), organ failure (e.g., hepatic encephalopathy), systemic inflammation (e.g., due to burns), and cardiac arrest (anoxic-ischemic encephalopathy). […] Coma can be prolonged in status epilepticus (e.g., nonconvulsive status epilepticus as diagnosed by EEG). […] Transient coma due to the temporary reduction of global brain perfusion, which can be due to cardiac etiologies, vasomotor etiologies, orthostatic hypotension, or pulmonary embolism. […] Seizures produce transient coma due to epileptiform discharges in the brain. […] Concussion is the transient impairment of consciousness due to a forceful displacement of the brain.

• #18 Coma: Types, Causes, Treatments, Prognosis

  https://www.webmd.com/brain/coma-types-causes-treatments-prognosis

  A coma is caused by an injury to the brain. Brain injury can be due to increased pressure, bleeding, loss of oxygen, or buildup of toxins. The injury can be temporary and reversible. It also can be permanent. […] More than 50% of comas are related to head trauma or disturbances in the brain’s circulatory system. Problems that can lead to a coma include: […] Anoxic brain injury: This is a brain condition caused by total lack of oxygen to the brain. Lack of oxygen for a few minutes causes cell death to brain tissues. Anoxic brain injury may result from heart attack (cardiac arrest), head injury or trauma, drowning, drug overdose, or poisoning. […] Trauma: Head injuries can cause the brain to swell and/or bleed. When the brain swells as a result of trauma, the fluid pushes up against the skull. The swelling may eventually cause the brain to push down on the brain stem, which can damage the reticular activating system (RAS) a part of the brain that’s responsible for arousal and awareness.

• #19 Medically Induced Coma- Things you must know!

  https://gnrchospitals.com/blogs/medically-induced-coma-get-answers-to-your-questions-here

  Reasons for medically induced coma include: Traumatic brain injury with swelling and increase in intracranial pressure, Stroke, Status Epilepticus – A type of seizure that lasts longer than 5 minutes, or two or more seizures within a 5-minute period, without returning to a normal level of consciousness between episodes, Drug overdose. […] The treatment for reducing brain swelling includes drugs like diuretics or steroids, draining excess fluids from inside the skull or increasing blood flow from the brain. However, when these options fail to generate a sufficient fall in brain pressure, a coma may be induced.

• #19 Medically Induced Coma- Things you must know!

  https://gnrchospitals.com/blogs/medically-induced-coma-get-answers-to-your-questions-here

  The word coma is often accompanied by a negative implication. This reaction is quite understandable, as a coma is a natural response by the body to a trauma of some severe kind. However, a coma can also be used as a medical tool- commonly referred to as a drug-induced coma or medically induced coma. It has been found to be effective in treating some patients, particularly those with severe brain injury. […] A medically induced coma uses medication to attain a deep state of brain inactivity. It is a reversible unconsciousness that doctors purposely induce to protect the brain from damage. […] Inducing a coma may give doctors an opportunity to alleviate the swelling and allows the brain to rest by decreasing the brains activity. It may also prevent the body from making false move in the process of healing itself.

• #20 Coma Management in Leesburg & Dulles, VA | Dr. Seth Tuwiner

  https://vaneurology.com/clinical-services/coma.php

  When there’s an injury to the brain because of a lack of oxygen, the brain experiences cell death. […] Brain death, as the name suggests, is the ending of all function in the brain. […] When a person’s brain swelling needs to be controlled, they may be put into a medically induced coma in an ICU to prevent the injured brain from dying.

• #21 What is a Coma? Duration, Recovery, and Brain Damage Risk

  https://brainfoundation.org.au/disorders/coma/

  Coma can happen for a number of reasons, such as: […] Coma is a state of unconsciousness in which the person doesnt respond their environment. It can be caused by a number of factors traumatic injuries (like a car crash), intoxication or overdose, diseases, neurological injuries such as stroke, and many other factors. […] In some instances, coma may be deliberately induced using pharmaceutical agents in order to preserve higher brain functions following brain trauma, or to save the patient from extreme pain during healing of injuries or diseases. All of these factors will influence the path through treatment and recovery, which is detailed below. […] The chances of someone recovering from a coma largely depend on the severity and cause of their brain injury, their age and how long theyve been in a coma. Its impossible to accurately predict whether the person will eventually recover, how long the coma will last and whether theyll have any long-term problems.

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

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

  Some conditions and circumstances can increase your risk of having a coma. These include: Metabolic conditions, especially ones that affect blood sugar levels, such as Type 1 diabetes and diabetes-related ketoacidosis (DKA), which is a rare complication of Type 2 diabetes. Chronic conditions such as high blood pressure (hypertension) and high cholesterol (hyperlipidemia), which can cause or contribute to problems like brain bleeds or strokes. Nonmedical substance and drug use (including use of opioid and sedative medications, alcohol use disorder, opioid use disorder, use of inhalants or any other type of substance use disorder). Not using safety restraints, helmets and other protective gear or items, leading to head injuries such as concussions or TBIs. Heart-related conditions (such as irregular heart rhythms). Other chronic conditions such as seizures, seizure-related conditions like epilepsy or low thyroid function (hypothyroidism).

• #23 Causes of brain dysfunction in acute coma: a cohort study of 1027 patients in the emergency department | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Full Text

  https://sjtrem.biomedcentral.com/articles/10.1186/s13049-019-0669-4

  Coma of unknown etiology (CUE) is a major challenge in emergency medicine. CUE is caused by a wide variety of pathologies that require immediate and targeted treatment. […] The data from our cohort show that the spectrum of conditions underlying CUE is broad and may include a surprisingly high number of coincidences of multiple coma-explaining pathologies. […] Coma of unknown etiology (CUE) denotes an acute impairment of consciousness that is not caused by traumatic brain injury (TBI) or cerebral hypoperfusion due to cardiac arrest. […] The existence of a newly acquired brain lesion including the early stages of an arterial occlusion or CNS inflammation remains to be the crucial classifier that divides class I from the rest. […] The mortality of our CUE patients significantly exceeds the mortality of multiple trauma, stroke or myocardial infarction.

• #23 Causes of brain dysfunction in acute coma: a cohort study of 1027 patients in the emergency department | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Full Text

  https://sjtrem.biomedcentral.com/articles/10.1186/s13049-019-0669-4

  Our data further show that transient CUE does by no means exclude a significant acute structural pathology. Approximately 25% of transient CUE patients had class I diagnoses associated with an in-hospital mortality rate of 14%. […] The data from our cohort show that the spectrum of conditions underlying CUE is broad and may include a surprisingly high number of coincidences of multiple coma-explaining pathologies. This finding has not been reported so far. Thus, significant pathologies may be masked by initial findings and only appear at the end of the diagnostic work-up.

• #24 Metabolic encephalopathy and metabolic coma | MedLink Neurology

  https://www.medlink.com/articles/metabolic-encephalopathy-and-metabolic-coma

  In this discussion we refer to the metabolic conditions as those due to organ dysfunction, nutritional deficiencies, electrolyte imbalances, hypoglycemia, hyperglycemia, endocrine disorders, medications, and systemic sepsis; the following are excluded: metabolic encephalopathies due to inborn errors of metabolism, cardiac arrest and anoxic-ischemic encephalopathy, direct CNS infections, exogenous toxins (including recreational drugs, alcohol, and poisons), hematological conditions, immune-mediated CNS diseases, and direct and indirect effects of cancer on the nervous system. […] Of note, metabolic encephalopathy is often due to multiple metabolic derangements rather than just one in isolation, reflecting the interaction among various organ systems. […] Table 2 lists the most commonly encountered metabolic encephalopathies in tertiary centers along with postulated mechanisms.

• #25 The etiology and outcome of non-traumatic coma in critical care: a systematic review | BMC Anesthesiology | Full Text

  https://bmcanesthesiol.biomedcentral.com/articles/10.1186/s12871-015-0041-9

  The primary outcome of interest for this review was mortality. […] The average mortality rate in NTC patients reported was 25-87% and varied markedly between studies. […] Coma etiology seemed to influence outcome. […] The in-hospital mortality associated with NTC as a result of metabolic derangements ranged from 15 to 86%. […] The most important reasons for NTC appeared to be: stroke, post-anoxic coma, poisoning and metabolic events. […] The mortality associated with post-anoxic coma ranged from 54% to 89%. […] Poisoning is another major reason for NTC. […] The associated in-hospital mortality was low (2.4%) but the one-year mortality was 10.9%. […] The cause of metabolic NTC is related to outcome.

• #25 The etiology and outcome of non-traumatic coma in critical care: a systematic review | BMC Anesthesiology | Full Text

  https://bmcanesthesiol.biomedcentral.com/articles/10.1186/s12871-015-0041-9

  Non-traumatic coma (NTC) is a serious condition requiring swift medical or surgical decision making upon arrival at the emergency department. […] Here, we present the results of a systematic literature search on the etiologies and prognosis of NTC. […] The most common causes of NTC were stroke (6-54%), post-anoxic coma (3-42%), poisoning (1-39%) and metabolic causes (1-29%). […] NTC was also often caused by infections, especially in African studies affecting 10-51% of patients. […] The mortality was highest for stroke (60-95%) and post-anoxic coma (54-89%) and lowest for poisoning (0-39%) and epilepsy (0-10%). […] The most common causes of NTC are stroke, post anoxic, poisoning and various metabolic etiologies. […] Knowledge of the most frequent causes of NTC may improve the management of these comatose patients.

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