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Coma

Overview

Coma refers to a deep state of unconsciousness where a person cannot be awakened and does not respond to stimuli (such as touch, sound, or light). Unlike sleep, a person in coma does not have normal sleep–wake cycles and shows little to no awareness of themselves or their surroundings. It is a medical emergency that requires immediate care.

Coma can be classified based on its cause and severity:

  • Structural coma: caused by direct brain injury, stroke, or tumour.
  • Metabolic/toxic coma: caused by low blood sugar, toxins, or organ failure.
  • Drug-induced coma: sometimes induced medically to protect the brain.

Since a coma means lack of consciousness, the key signs include:

  • No response to sound, touch, or other stimuli
  • No meaningful speech or voluntary movement
  • Absence of normal sleep–wake cycles
  • Sometimes abnormal posturing (involuntary stiff movements) or irregular breathing patterns

Coma can result from many conditions that disrupt brain function, such as:

  • Traumatic brain injury
  • Stroke and other vascular disorders
  • Meningitis and encephalitis
  • Metabolic disorders like hypoglycaemia or hyperglycaemia
  • Toxins
  • Mass lesions in brain
  • Hypoxic brain damage (lack of oxygen to the brain)

Doctors assess coma severity and underlying causes using:

  • Clinical examination: checking reflexes, movements, and pupil responses.
  • Glasgow Coma Scale (GCS): scoring eye, verbal, and motor responses. Glasgow coma scale score:
  • 3–8 : Severe coma
  • 9–12: Moderate coma
  • 13–15: Mild coma
  • EEG (electroencephalogram): to measure brain activity (shows slowed signals).
  • Evoked potentials: tests how the brain responds to stimuli.
  • Brain imaging (CT or MRI scans): to identify stroke, injury, or tumours.
  • Blood tests: to detect infections, toxins, or metabolic issues.

Treatment depends on the underlying cause but usually includes:

  • Supportive measures: maintaining breathing, circulation, and nutrition.
  • Management of secondary complications: such as infections, bed sores, and muscle stiffness.
  • Treatment of underlying pathology:
  • Insulin for low or high blood sugar.
  • Antibiotics for infections.
  • Surgery for brain tumours or bleeding.
  • Rehabilitation: if the patient regains consciousness, therapies are needed to restore movement, speech, and memory.

Coma is a medical emergency. Call for immediate medical help if someone:

  • Becomes suddenly unconscious.
  • Fails to respond to stimuli (voice, touch, or pain).
  • Shows sudden severe confusion, seizures, or abnormal breathing before losing consciousness.

Not all comas can be prevented, but risks can be reduced by:

  • Managing chronic conditions like diabetes, high blood pressure, and kidney disease.
  • Wearing helmets and seatbelts to prevent head injuries.
  • Avoiding excessive alcohol and drug use.
  • Prompt treatment of infections that can spread to the brain.

Patients in a coma are managed by a hospital emergency team initially. Long-term care is coordinated by a Neurologist (specialist in brain and nerve disorders) or Critical care specialist / Intensivist (for ICU management).

Disclaimer:

The information in this Health Library is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional with any questions about a medical condition or before starting any treatment. Use of this site and its content does not establish a doctor–patient relationship. In case of a medical emergency, call your local emergency number or visit the nearest emergency facility immediately.