A coma is a prolonged state of unconsciousness. Common causes of comas include traumatic brain injury, an overload of toxins (from carbon monoxide to a drug overdose), a lack of oxygen such as that caused by drowning, nervous system infections, and extremely high or low levels of blood sugar.
The appropriate treatment depends largely on the underlying cause, and there isn’t always a cure for a comatose patient. Here’s a look at some of the treatment options for comas.
Treatments for Bleeding or Swelling
Traumatic brain injuries and some infections cause comas because of the pressure put on the brain as a result of the swelling or bleeding that results. Bleeding can cause the brain to shift slightly out of place, while swelling is an issue because the brain only has so much space to expand into before it runs into its enclosing tissue and bone.
In this case, the goal of treatment is to stop or reverse the swelling or bleeding. Hypertonic saline can control the pressure that results from swelling. It works as a kind of brain diuretic, pulling excess fluid out through the blood vessels so the urinary system can get rid of it. A decompressive craniectomy is a surgical procedure in which part of the skull is removed so that the brain has the room to swell. A craniotomy, on the other hand, is a procedure that allows surgeons to repair some types of damage in the brain; this may mean removing blood clots or repairing fractures.
Treating the Underlying Cause
In some cases, the most important aspect of treating the coma is to determine whatever caused it. For example, when blood sugar gets too high (hyperglycemia) or too low (hypoglycemia), it can cause a coma. Returning blood sugar to a safe level can often reverse the comatose state.
When an overdose of drugs or alcohol is at fault, doctors may begin by attempting to get as much of the substance as possible out of the system (if early enough), followed by administering appropriate medications to try to reverse the damage.
Other toxins, like those produced by liver disease, can be helped through other therapies or medications appropriate to the situation. When meningitis or encephalitis are the culprit, administering antibiotics to get rid of the underlying bacterial infection can often help.
Other Aspects of Coma Treatment
No matter what the cause is, the most important aspect of coma treatment is speed. A coma is always a medical emergency and merits immediate medical attention for the best prognosis. However, in some cases, no amount of speed or treatment can undo the damage incurred. Furthermore, it is important to remember that while treatment can reverse the coma, it can’t always reverse the damage caused by whatever brought on the coma. For example, when hypoxia occurs, brain cells can begin dying extremely quickly without appropriate oxygen. While the human brain is quite plastic in childhood and often able to make new pathways to replace those that are damaged, this ability recedes in adulthood, making it harder and harder for the brain to recover from serious damage.