Coma etiology, diagnosis and treatment possibilities

Vytautas Jašinskas1, Monika Jašinskaitė1

1Lithuanian University of Health Sciences


Coma is a long-term, deep, non-irritable unconsciousness that occurs due to retinal damage or diffuse cortical dysfunction and lasts for at least one hour to distinguish between short-term consciousness disorder [1]. In Intensive care units every year treated a large number of people who have different age and various etiology of coma. For most people coma ends with death or causes functional disorders [2]. The prevalence and causes of coma depend on the location of the geography area and demographic indicators, for example, 175-200 / 100,000 people in the United States experience coma and 56,000 die every year [3]. Coma may be neurogenic, metabolic (endogenous or exogenous) and psychogenic etiology [4]. The most common coma is neurogenic or metabolic etiology, and coma of psychogenic origin is very rarely diagnosed, for example, in a study of 500 obscure coma cases by Plump and Posner, only 8 (0.8%) of psychogenic coma were identified [5]. Primary brain damage that causes neurogenic coma is usually associated with changes in the cerebral artery and metabolic coma is due to diffuse damage to the cerebral cortex [6]. Two scales are commonly used to diagnose coma: GCS (Glasgow Coma Scale) or Four Scale (Full Outline of UnResponsiveness). Graham Teasdale, professor at Glasgow University, said that the GCS scale is not only accurate, reliable, but also allows easy communication between doctors in different professions [7]. The Four Scale is newer and more appropriate to assess the state of consciousness in intubated patients. Diagnosing the cause of coma may be difficult, because, due to patient health condition, their are not able to provide the necessary information about their health condition to the physician, then collaboration between doctors and the relatives, the ambulance staff and the people who know something about that patient is very important. Coma patient treatment should start with monitoring and stabilizing vital functions according to the ABCDE principle. Treatment tactic should be selected considering coma etiology and the results of diagnostic examination. Coma patient outcomes depends by causes of coma, however some authors reported that the mortality rate of coma patients may be higher than 87 % [3].

Keywords: coma, etiology, diagnosis, treatment.