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What is Coma, including Persistent Vegetative State?
A
coma is a profound or deep state of unconsciousness. The affected individual is
alive but is not able to react or respond to life around him/her. Coma may occur
as an expected progression or complication of an underlying illness, or as a
result of an event such as head trauma. A persistent vegetative state, which
sometimes follows a coma, refers to a condition in which individuals have lost
cognitive neurological function and awareness of the environment but retain
noncognitive function and a perserved sleep-wake cycle. It is sometimes
described as when a person is technically alive, but his/her brain is dead.
However, that description is not completely accurate. In persistent vegetative
state the individual loses the higher cerebral powers of the brain, but the
functions of the brainstem, such as respiration (breathing) and circulation,
remain relatively intact. Spontaneous movements may occur and the eyes may open
in response to external stimuli, but the patient does not speak or obey
commands. Patients in a vegetative state may appear somewhat normal. They may
occasionally grimace, cry, or laugh.
Is there any treatment?
Once the
patient is out of immediate danger, although still in coma or vegetative state,
the medical care team will concentrate on preventing infections and maintaining
the patient's physical state as much as possible. Such maintenance includes
preventing pneumonia and bed sores and providing balanced nutrition. Physical
therapy may also be used to prevent contractures (permanent muscular
contractions) and orthopedic deformities that would limit recovery for the
patients who emerge from coma.
What is the prognosis?
The outcome for
coma and vegetative state depends on the cause and on the location, severity,
and extent of neurological damage: outcomes range from recovery to death. People
may emerge from a coma with a combination of physical, intellectual, and
psychological difficulties that need special attention. Recovery usually occurs
gradually, with patients acquiring more and more ability to respond. Some
patients never progress beyond very basic responses, but many recover full
awareness. Patients recovering from coma require close medical supervision. A
coma rarely lasts more than 2 to 4 weeks. Some patients may regain a degree of
awareness after vegetative state. Others may remain in a vegetative state for
years or even decades. The most common cause of death for a person in a
vegetative state is infection such as pneumonia.
What research is being done?
The NINDS
supports research on neurological conditions such as coma and persistent
vegetative state. This research is aimed at finding ways to prevent, treat, and
cure these conditions.
Selected references
Plum, F., Disturbances of Consciousness and Arousal In Cecil Textbook of
Medicine, 19th edition, W.B. Saunders Co., Philadelphia, pp. 2048-2063 (1992)
Harris, J, and Berger, J., Clinical Approach to Stupor and Coma Chapter 5 in
Neurology in Clinical Practice, Vol. 1, Butterworth-Heinemann, Boston, pp. 43-63
(1991)
Organizations
Coma Recovery Association
807 Carman Avenue
Westbury, NY 11590
office@comarecovery.org
http://comarecovery.org/
Tel: 516-997-1826
Fax: 516-997-1613
Brain Injury Association
105 North Alfred Street
Alexandria, VA 22314
publicrelations@biausa.org
http://www.biausa.org/
Tel: 703-236-6000 800-444-6443
Fax: 703-236-6001
Family Caregiver Alliance
690 Market Street Suite 600
San Francisco, CA 94104
info@caregiver.org
http://www.caregiver.org/
Tel: 415-434-3388 800-445-8106
Fax: 415-434-3508
National Rehabilitation Information Center (NARIC)
1010 Wayne Avenue Suite 800
Silver Spring, MD 20910-5633
naricinfo@kra.com
http://www.naric.com/
Tel: 301-562-2400 800-346-2742
Fax: 301-562-2401
National Stroke Association
9707 East Easter Lane
Englewood, CO 80112-3747
info@stroke.org
http://www.stroke.org/
Tel: 303-649-9299 800-STROKES (787-6537)
Fax: 303-649-1328
Source: National Institutes of Health; National Institute of
Neurological Disorders and Stroke
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