brain, spinal cord, and nerve disorders
Stupor and Coma
Prognosis for Stupor and Coma
In general, if people with impaired consciousness start to respond to sounds, touch, or other stimuli within 6 hours, they are more likely to recover. Recovery is also likely if one or more of the following occur within the first days: Speech returns, even if it is incomprehensible. The eyes can follow an object. People can follow commands. Muscle tone returns to normal. The likelihood of recovery also depends on the cause and duration of impaired consciousness, as in the following: Overdose of a sedative:Recovery is likely unless people stopped breathing long enough to cause brain damage. A low blood sugar level:Complete recovery is possible if the brain was not deprived of sugar for more than about 1 hour. Head injury:Substantial recovery may occur, even if the coma lasts several weeks (but not if it lasts more than 3 months). Stroke:Permanent brain damage is likely if coma lasts 6 hours or longer. Infection:Complete recovery is often possible if people are promptly treated. Having another disorder (such as diabetes mellitus, high blood pressure, or a lung or heart disorder), if it is severe, may negatively affect recovery. Also, spending a long time in intensive care unit (ICU) can cause problems such as nerve damage, weak muscles, Pulmonary Embolism (PE) , Aftercardiac arrest,full recovery is rare if people have any of the following: Certain disorders such as heart disorders, high blood pressure, or diabetes mellitus Coma for more than 6 hours Unintended (involuntary) muscle movements (usually muscle twitches) Abnormal extension of the limbs ( Neurologic examination ) or no response to painful stimulation Pupils that do not react to light after 1 to 3 days Seizures that occur within 24 to 48 hours after cardiac arrest and that recur repeatedly If people cannot move their limbs after cardiac arrest, recovery is difficult. However, if doctors have used cooling to treat people after cardiac arrest, they usually wait an extra 3 days for these responses to occur. Cooling the body may preserve brain function after cardiac arrest, but it also tends to slow recovery of brain function. Sometimes doctors use a test called somatosensory Evoked Responses to determine whether the brain stem or cerebral hemispheres can function. For this test, electrodes, which produce a mild electrical signal, are placed on parts of the body, and EEG is used to detect and record how long the electrical signal takes to reach the brain. Similarly, auditory evoked responses use clicking sounds in each ear to test if hearing signals reach the brain. If evoked response signals repeatedly do not reach the brain, the prognosis tends to be poor. Children and sometimes young adults recover more fully than older people because brain cells repair themselves more quickly and completely in the young. For people who remain in a deep coma longer than a few weeks, decisions about continued use of a ventilator, feeding tube, and drugs should be made. Family members should discuss these issues with the doctors. If people have Advance Directives , such as a living will or durable power of attorney for health care, the directives should guide decisions about continuing care. 