Traumatic Coma

What Is It?

A traumatic coma is a decrease in the level of consciousness due to a traumatic injury to the head. Generally, it is defined as a state of consciousness in which the victim is not conscious and does not respond appropriately to external stimuli.

It is not an absolute term, however. The depth of a coma can vary considerably depending on the severity of the brain injury. While a patient with a very severe brain injury may have no reaction at all to any external stimuli, including painful ones, patients with less severe injury may respond to stimuli with certain automatic reflexes from the brain stem and brain. Physicians and other clinicians often grade the level of consciousness with a scale called the Glasgow Coma Scale or GCS. It helps to quickly communicate the severity of traumatic injury and the depth of unconsciousness as well as helping to predict prognosis.

Certain parts of the brain are required for normal alertness and what we consider a waking state of consciousness. If enough of those areas are injured, either stunned temporarily or damaged permanently, a victim of head trauma can have a disorder of consciousness. If the underlying cause of the brain injury or irritation is reversible, patients can recover partially or completely from this state. If the underlying injury is too severe and permanent, some patients may never recover from this state. This depends on the specifics of each case and cannot be generalized here.

What Types of Symptoms Are Typical?

By definition, a traumatic coma results in a depressed level of consciousness. In addition to a lack of alertness and arousability, these patients can display some automatic reflexes in response to external stimuli. In the most severe brain injury, no response may be found to painful stimuli. However, abnormal reflexes such as decerebrate (extensor) posturing or decorticate (flexor) posturing can occur. In more superficial levels of unconsciousness, the patient may even withdraw from stimuli or even localize, reaching up to grab or push away a stimulus. These do not necessarily imply a conscious patient, simply that higher levels of their brain function are intact. These neurological exam findings can vary even in a given patient. The GCS is often used to track this depth of coma over time acutely in the hospital after injury.

How Is The Diagnosis Typically Made?

A traumatic coma is generally obvious if the patient has clearly suffered a head injury and is in an unconscious state. While a brief loss of consciousness immediately following the injury is not necessarily a coma, and may be considered a concussion, any prolonged unconscious state is.

After such an injury, following an initial trauma stabilization and evaluation, most patients will undergo a CT scan of the head to determine if there are any intracranial injuries, such as bleeding in the head, in or around the brain, or brain swelling.

What Are Some Common Treatments?

The treatment of traumatic brain injury is complex and often prolonged. It varies considerably depending on the type of intracranial injury, the severity, the characteristics of the patient and many other factors.

Unconscious patients are usually managed initially in the intensive care unit and many will require mechanical ventilation to breath. Those patients with significant bleeding inside the head will sometimes undergo surgery to remove the blood and relieve pressure on the brain. Other treatments such as placement of a ventriculostomy to drain cerebrospinal fluid pressure and monitor intracranial pressure are often done as well. Many medical treatments with various medications are often used as well. If patients survive the acute period following injury, they often require long-term rehabilitation.

The details of treatment for traumatic brain injuries is too complex and variable to cover completely here. These treatment plans vary from patient to patient and should be discussed with each patient's own treating physicians.

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Important Note: This site is not intended to offer medical advice. Every patient is different, and only your personal physician can help to counsel you about what is best for your situation. What we offer is general reference information about various disorders and treatments for your education.

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