What are the manifestations of a sudden coma that goes from mild to severe?
Coma is a common clinical manifestation due to impaired structural and functional activity of the higher central nervous system, resulting in severe and persistent impairment of consciousness with vital signs. In addition to severe neurological disorders, severe impairment of vital organ function can also lead to coma. It is characterized by a rapid onset and rapid progression, often life-threatening or severely disabling.
Shallow coma. Once in a coma (COMA) state, the patient presents with loss of consciousness, inability to wake up by shouting, i.e., complete loss of response to the second signaling system. At this time, strong painful stimuli, such as pressing the upper orbital border, may have a painful expression and avoidance reflex, and there may be less unconscious spontaneous movements. The abdominal wall reflex is absent, but the corneal reflex, pupillary light reflex, cough reflex, swallowing reflex, and tendon reflex are present, and there is no significant change in vital signs. Inhibition reaches the cortex.
The patient loses voluntary movements, does not respond to general stimuli, responds to strong painful stimuli such as orbital compression, nail root compression, etc., superficial reflexes disappear, tendon reflexes, glossopharyngeal reflexes, corneal reflexes, pupillary light reflexes exist, and there are no obvious changes in breathing and pulse. It can be seen in severe cerebrovascular disease, encephalitis, brain abscess, brain tumor, poisoning, early shock, hepatic encephalopathy, etc.
Moderate coma. The patient's eyes are open, speech, and spontaneous movements are lost, and the patient does not respond to various external stimuli, and may have a defensive reflex in response to strong painful stimuli. There is no movement of the eyeball, the corneal reflex is weakened, the pupil reflex to light is dulled, and breathing is slowed or increased, and central respiratory disorders such as periodic breathing and central neuron hyperventilation can be seen. There are also changes in pulse and blood pressure. With or without limb tonic extension and angular arch reflexion (decortical rigidity). Retention or incontinence.
Deep coma. The muscles of the whole body are relaxed, and the escape response and decortical rigidity cannot be elicited in response to strong painful stimuli. The eyeball is fixed, the pupil is significantly dilated, and the pupillary light reflex, corneal reflex, anterior vestibular reflex, swallowing reflex, cough reflex, and plantar reflex all disappear. Irregular breathing, blood pressure may drop, incontinence, and occasionally retention.
Brain death. The main clinical manifestations are: (1) deep coma: the patient does not respond to external environmental stimuli such as speech or pain, and does not have any spontaneous movements; (2) Spontaneous respiratory arrest and ventilation must be maintained with a ventilator; (3) Five important brainstem reflex disorders, including loss of light reflex and fixed pupil dilation, loss of corneal reflex, loss of eye movement in doll head test, loss of ocular veil reflex, loss of gag reflex, lasting at least 12 hours; (4) The EEG is in a straight line and does not respond to any stimulus, which is maintained for at least 30 minutes; Brainstem auditory evoked potentials do not elicit waveforms; (5) The tendon reflex, abdominal wall reflex and the response of the neck below the neck to painful stimuli can disappear or exist; (6) Drug poisoning, low temperature and endocrine metabolism must be excluded. The presence of a cerebrotraumatic or cortexticated tonic seizure indicates that the brainstem is still functional and cannot be diagnosed as brain death.
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