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class="vector-toc-numb">2</span> <span>Signs and symptoms</span> </div> </a> <ul id="toc-Signs_and_symptoms-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Causes" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Causes"> <div class="vector-toc-text"> <span class="vector-toc-numb">3</span> <span>Causes</span> </div> </a> <ul id="toc-Causes-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Pathophysiology" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Pathophysiology"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Pathophysiology</span> </div> </a> <ul id="toc-Pathophysiology-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Diagnosis" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Diagnosis"> <div class="vector-toc-text"> <span class="vector-toc-numb">5</span> <span>Diagnosis</span> </div> </a> <button aria-controls="toc-Diagnosis-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Diagnosis subsection</span> </button> <ul id="toc-Diagnosis-sublist" class="vector-toc-list"> <li id="toc-Initial_evaluation" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Initial_evaluation"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.1</span> <span>Initial evaluation</span> </div> </a> <ul id="toc-Initial_evaluation-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Imaging_and_testing" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Imaging_and_testing"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.2</span> <span>Imaging and testing</span> </div> </a> <ul id="toc-Imaging_and_testing-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Body_movements" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Body_movements"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.3</span> <span>Body movements</span> </div> </a> <ul id="toc-Body_movements-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Pupil_size" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Pupil_size"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.4</span> <span>Pupil size</span> </div> </a> <ul id="toc-Pupil_size-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Severity" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Severity"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.5</span> <span>Severity</span> </div> </a> <ul id="toc-Severity-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Treatment" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Treatment"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>Treatment</span> </div> </a> <button aria-controls="toc-Treatment-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Treatment subsection</span> </button> <ul id="toc-Treatment-sublist" class="vector-toc-list"> <li id="toc-Continued_care" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Continued_care"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.1</span> <span>Continued care</span> </div> </a> <ul id="toc-Continued_care-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Caregivers" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Caregivers"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.2</span> <span>Caregivers</span> </div> </a> <ul id="toc-Caregivers-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Prognosis" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Prognosis"> <div class="vector-toc-text"> <span class="vector-toc-numb">7</span> <span>Prognosis</span> </div> </a> <button aria-controls="toc-Prognosis-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Prognosis subsection</span> </button> <ul id="toc-Prognosis-sublist" class="vector-toc-list"> <li id="toc-Recovery" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Recovery"> <div class="vector-toc-text"> <span class="vector-toc-numb">7.1</span> <span>Recovery</span> </div> </a> <ul id="toc-Recovery-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Society_and_culture" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Society_and_culture"> <div class="vector-toc-text"> <span class="vector-toc-numb">8</span> <span>Society and culture</span> </div> </a> <button aria-controls="toc-Society_and_culture-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Society and culture subsection</span> </button> <ul id="toc-Society_and_culture-sublist" class="vector-toc-list"> <li id="toc-Bioethics" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Bioethics"> <div class="vector-toc-text"> <span class="vector-toc-numb">8.1</span> <span>Bioethics</span> </div> </a> <ul id="toc-Bioethics-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> <span class="vector-toc-numb">9</span> <span>See also</span> </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> <span class="vector-toc-numb">10</span> <span>References</span> </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> <span class="vector-toc-numb">11</span> <span>External links</span> </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" title="Table of Contents" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" ><span class="vector-icon mw-ui-icon-listBullet mw-ui-icon-wikimedia-listBullet"></span> <span class="vector-dropdown-label-text">Toggle the table of contents</span> </label> <div class="vector-dropdown-content"> <div id="vector-page-titlebar-toc-unpinned-container" class="vector-unpinned-container"> </div> </div> </div> </nav> <h1 id="firstHeading" class="firstHeading mw-first-heading"><span class="mw-page-title-main">Coma</span></h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-p-lang-btn" class="vector-dropdown-checkbox mw-interlanguage-selector" aria-label="Go to an article in another language. Available in 78 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-78" aria-hidden="true" ><span class="vector-icon mw-ui-icon-language-progressive mw-ui-icon-wikimedia-language-progressive"></span> <span class="vector-dropdown-label-text">78 languages</span> </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-af mw-list-item"><a href="https://af.wikipedia.org/wiki/Koma" title="Koma – Afrikaans" lang="af" hreflang="af" data-title="Koma" data-language-autonym="Afrikaans" data-language-local-name="Afrikaans" class="interlanguage-link-target"><span>Afrikaans</span></a></li><li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D8%BA%D9%8A%D8%A8%D9%88%D8%A8%D8%A9" title="غيبوبة – Arabic" lang="ar" hreflang="ar" data-title="غيبوبة" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target"><span>العربية</span></a></li><li class="interlanguage-link interwiki-roa-rup mw-list-item"><a href="https://roa-rup.wikipedia.org/wiki/Com%C3%A2" title="Comâ – Aromanian" lang="rup" hreflang="rup" data-title="Comâ" data-language-autonym="Armãneashti" data-language-local-name="Aromanian" class="interlanguage-link-target"><span>Armãneashti</span></a></li><li class="interlanguage-link interwiki-ast mw-list-item"><a href="https://ast.wikipedia.org/wiki/Coma_(m%C3%A9dicu)" title="Coma (médicu) – Asturian" lang="ast" hreflang="ast" data-title="Coma (médicu)" data-language-autonym="Asturianu" data-language-local-name="Asturian" class="interlanguage-link-target"><span>Asturianu</span></a></li><li class="interlanguage-link interwiki-az mw-list-item"><a href="https://az.wikipedia.org/wiki/Koma" title="Koma – Azerbaijani" lang="az" hreflang="az" data-title="Koma" data-language-autonym="Azərbaycanca" data-language-local-name="Azerbaijani" class="interlanguage-link-target"><span>Azərbaycanca</span></a></li><li class="interlanguage-link interwiki-bn mw-list-item"><a href="https://bn.wikipedia.org/wiki/%E0%A6%B8%E0%A6%82%E0%A6%9C%E0%A7%8D%E0%A6%9E%E0%A6%BE%E0%A6%B9%E0%A7%80%E0%A6%A8%E0%A6%A4%E0%A6%BE" title="সংজ্ঞাহীনতা – Bangla" lang="bn" hreflang="bn" data-title="সংজ্ঞাহীনতা" data-language-autonym="বাংলা" data-language-local-name="Bangla" class="interlanguage-link-target"><span>বাংলা</span></a></li><li class="interlanguage-link interwiki-ba mw-list-item"><a href="https://ba.wikipedia.org/wiki/%D0%9A%D0%BE%D0%BC%D0%B0" title="Кома – Bashkir" lang="ba" hreflang="ba" data-title="Кома" data-language-autonym="Башҡортса" data-language-local-name="Bashkir" class="interlanguage-link-target"><span>Башҡортса</span></a></li><li class="interlanguage-link interwiki-be mw-list-item"><a href="https://be.wikipedia.org/wiki/%D0%9A%D0%BE%D0%BC%D0%B0" title="Кома – Belarusian" lang="be" hreflang="be" data-title="Кома" data-language-autonym="Беларуская" data-language-local-name="Belarusian" class="interlanguage-link-target"><span>Беларуская</span></a></li><li class="interlanguage-link interwiki-be-x-old mw-list-item"><a href="https://be-tarask.wikipedia.org/wiki/%D0%9A%D0%BE%D0%BC%D0%B0" title="Кома – Belarusian (Taraškievica orthography)" lang="be-tarask" hreflang="be-tarask" data-title="Кома" data-language-autonym="Беларуская (тарашкевіца)" data-language-local-name="Belarusian (Taraškievica orthography)" class="interlanguage-link-target"><span>Беларуская (тарашкевіца)</span></a></li><li class="interlanguage-link interwiki-bg mw-list-item"><a href="https://bg.wikipedia.org/wiki/%D0%9A%D0%BE%D0%BC%D0%B0" title="Кома – Bulgarian" lang="bg" hreflang="bg" data-title="Кома" data-language-autonym="Български" data-language-local-name="Bulgarian" class="interlanguage-link-target"><span>Български</span></a></li><li class="interlanguage-link interwiki-bs mw-list-item"><a href="https://bs.wikipedia.org/wiki/Koma" title="Koma – Bosnian" lang="bs" hreflang="bs" data-title="Koma" data-language-autonym="Bosanski" data-language-local-name="Bosnian" class="interlanguage-link-target"><span>Bosanski</span></a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/Coma_(medicina)" title="Coma (medicina) – Catalan" lang="ca" hreflang="ca" data-title="Coma (medicina)" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target"><span>Català</span></a></li><li class="interlanguage-link interwiki-cs mw-list-item"><a href="https://cs.wikipedia.org/wiki/K%C3%B3ma" title="Kóma – Czech" lang="cs" hreflang="cs" data-title="Kóma" data-language-autonym="Čeština" data-language-local-name="Czech" class="interlanguage-link-target"><span>Čeština</span></a></li><li class="interlanguage-link interwiki-da mw-list-item"><a href="https://da.wikipedia.org/wiki/Koma" title="Koma – Danish" lang="da" hreflang="da" data-title="Koma" data-language-autonym="Dansk" data-language-local-name="Danish" class="interlanguage-link-target"><span>Dansk</span></a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Koma" title="Koma – German" lang="de" hreflang="de" data-title="Koma" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target"><span>Deutsch</span></a></li><li class="interlanguage-link interwiki-et mw-list-item"><a href="https://et.wikipedia.org/wiki/Kooma" title="Kooma – Estonian" lang="et" hreflang="et" data-title="Kooma" data-language-autonym="Eesti" data-language-local-name="Estonian" class="interlanguage-link-target"><span>Eesti</span></a></li><li class="interlanguage-link interwiki-el mw-list-item"><a href="https://el.wikipedia.org/wiki/%CE%9A%CF%8E%CE%BC%CE%B1" title="Κώμα – Greek" lang="el" hreflang="el" data-title="Κώμα" data-language-autonym="Ελληνικά" data-language-local-name="Greek" class="interlanguage-link-target"><span>Ελληνικά</span></a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Coma_(medicina)" title="Coma (medicina) – Spanish" lang="es" hreflang="es" data-title="Coma (medicina)" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target"><span>Español</span></a></li><li class="interlanguage-link interwiki-eo mw-list-item"><a href="https://eo.wikipedia.org/wiki/Komato" title="Komato – Esperanto" lang="eo" hreflang="eo" data-title="Komato" data-language-autonym="Esperanto" data-language-local-name="Esperanto" class="interlanguage-link-target"><span>Esperanto</span></a></li><li class="interlanguage-link interwiki-eu mw-list-item"><a href="https://eu.wikipedia.org/wiki/Koma_(egoera)" title="Koma (egoera) – Basque" lang="eu" hreflang="eu" data-title="Koma (egoera)" data-language-autonym="Euskara" data-language-local-name="Basque" class="interlanguage-link-target"><span>Euskara</span></a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%DA%A9%D9%85%D8%A7" title="کما – Persian" lang="fa" hreflang="fa" data-title="کما" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target"><span>فارسی</span></a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/Coma" title="Coma – French" lang="fr" hreflang="fr" data-title="Coma" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target"><span>Français</span></a></li><li class="interlanguage-link interwiki-ga mw-list-item"><a href="https://ga.wikipedia.org/wiki/C%C3%B3ma" title="Cóma – Irish" lang="ga" hreflang="ga" data-title="Cóma" data-language-autonym="Gaeilge" data-language-local-name="Irish" class="interlanguage-link-target"><span>Gaeilge</span></a></li><li class="interlanguage-link interwiki-gl mw-list-item"><a href="https://gl.wikipedia.org/wiki/Coma_(medicina)" title="Coma (medicina) – Galician" lang="gl" hreflang="gl" data-title="Coma (medicina)" data-language-autonym="Galego" data-language-local-name="Galician" class="interlanguage-link-target"><span>Galego</span></a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%ED%98%BC%EC%88%98%EC%83%81%ED%83%9C" title="혼수상태 – Korean" lang="ko" hreflang="ko" data-title="혼수상태" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target"><span>한국어</span></a></li><li class="interlanguage-link interwiki-hy mw-list-item"><a href="https://hy.wikipedia.org/wiki/%D4%BF%D5%B8%D5%B4%D5%A1" title="Կոմա – Armenian" lang="hy" hreflang="hy" data-title="Կոմա" data-language-autonym="Հայերեն" data-language-local-name="Armenian" class="interlanguage-link-target"><span>Հայերեն</span></a></li><li class="interlanguage-link interwiki-hi mw-list-item"><a href="https://hi.wikipedia.org/wiki/%E0%A4%A8%E0%A4%BF%E0%A4%B6%E0%A5%8D%E0%A4%9A%E0%A5%87%E0%A4%A4%E0%A4%A8%E0%A4%A4%E0%A4%BE" title="निश्चेतनता – Hindi" lang="hi" hreflang="hi" data-title="निश्चेतनता" data-language-autonym="हिन्दी" data-language-local-name="Hindi" class="interlanguage-link-target"><span>हिन्दी</span></a></li><li class="interlanguage-link interwiki-hr mw-list-item"><a href="https://hr.wikipedia.org/wiki/Koma" title="Koma – Croatian" lang="hr" hreflang="hr" data-title="Koma" data-language-autonym="Hrvatski" data-language-local-name="Croatian" class="interlanguage-link-target"><span>Hrvatski</span></a></li><li class="interlanguage-link interwiki-io mw-list-item"><a href="https://io.wikipedia.org/wiki/Komato" title="Komato – Ido" lang="io" hreflang="io" data-title="Komato" data-language-autonym="Ido" data-language-local-name="Ido" class="interlanguage-link-target"><span>Ido</span></a></li><li class="interlanguage-link interwiki-ig mw-list-item"><a href="https://ig.wikipedia.org/wiki/%E1%BB%8Cr%E1%BB%8Ba_coma" title="Ọrịa coma – Igbo" lang="ig" hreflang="ig" data-title="Ọrịa coma" data-language-autonym="Igbo" data-language-local-name="Igbo" class="interlanguage-link-target"><span>Igbo</span></a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Koma_(medis)" title="Koma (medis) – Indonesian" lang="id" hreflang="id" data-title="Koma (medis)" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target"><span>Bahasa Indonesia</span></a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Coma" title="Coma – Italian" lang="it" hreflang="it" data-title="Coma" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target"><span>Italiano</span></a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%AA%D7%A8%D7%93%D7%9E%D7%AA" title="תרדמת – Hebrew" lang="he" hreflang="he" data-title="תרדמת" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target"><span>עברית</span></a></li><li class="interlanguage-link interwiki-ka mw-list-item"><a href="https://ka.wikipedia.org/wiki/%E1%83%99%E1%83%9D%E1%83%9B%E1%83%90" title="კომა – Georgian" lang="ka" hreflang="ka" data-title="კომა" data-language-autonym="ქართული" data-language-local-name="Georgian" class="interlanguage-link-target"><span>ქართული</span></a></li><li class="interlanguage-link interwiki-kk mw-list-item"><a href="https://kk.wikipedia.org/wiki/%D0%9A%D0%BE%D0%BC%D0%B0" title="Кома – Kazakh" lang="kk" hreflang="kk" data-title="Кома" data-language-autonym="Қазақша" data-language-local-name="Kazakh" class="interlanguage-link-target"><span>Қазақша</span></a></li><li class="interlanguage-link interwiki-ky mw-list-item"><a href="https://ky.wikipedia.org/wiki/%D0%9A%D0%BE%D0%BC%D0%B0_(%D0%BC%D0%B5%D0%B4%D0%B8%D1%86%D0%B8%D0%BD%D0%B0)" title="Кома (медицина) – Kyrgyz" lang="ky" hreflang="ky" data-title="Кома (медицина)" data-language-autonym="Кыргызча" data-language-local-name="Kyrgyz" class="interlanguage-link-target"><span>Кыргызча</span></a></li><li class="interlanguage-link interwiki-lv mw-list-item"><a href="https://lv.wikipedia.org/wiki/Koma" title="Koma – Latvian" lang="lv" hreflang="lv" data-title="Koma" data-language-autonym="Latviešu" data-language-local-name="Latvian" class="interlanguage-link-target"><span>Latviešu</span></a></li><li class="interlanguage-link interwiki-lt mw-list-item"><a href="https://lt.wikipedia.org/wiki/Koma" title="Koma – Lithuanian" lang="lt" hreflang="lt" data-title="Koma" data-language-autonym="Lietuvių" data-language-local-name="Lithuanian" class="interlanguage-link-target"><span>Lietuvių</span></a></li><li class="interlanguage-link interwiki-li mw-list-item"><a href="https://li.wikipedia.org/wiki/Coma" title="Coma – Limburgish" lang="li" hreflang="li" data-title="Coma" data-language-autonym="Limburgs" data-language-local-name="Limburgish" class="interlanguage-link-target"><span>Limburgs</span></a></li><li class="interlanguage-link interwiki-hu badge-Q17437796 badge-featuredarticle mw-list-item" title="featured article badge"><a href="https://hu.wikipedia.org/wiki/K%C3%B3ma_(orvostudom%C3%A1ny)" title="Kóma (orvostudomány) – Hungarian" lang="hu" hreflang="hu" data-title="Kóma (orvostudomány)" data-language-autonym="Magyar" data-language-local-name="Hungarian" class="interlanguage-link-target"><span>Magyar</span></a></li><li class="interlanguage-link interwiki-mk mw-list-item"><a href="https://mk.wikipedia.org/wiki/%D0%9A%D0%BE%D0%BC%D0%B0" title="Кома – Macedonian" lang="mk" hreflang="mk" data-title="Кома" data-language-autonym="Македонски" data-language-local-name="Macedonian" class="interlanguage-link-target"><span>Македонски</span></a></li><li class="interlanguage-link interwiki-ml mw-list-item"><a href="https://ml.wikipedia.org/wiki/%E0%B4%95%E0%B5%8B%E0%B4%AE_(%E0%B4%B5%E0%B5%88%E0%B4%A6%E0%B5%8D%E0%B4%AF%E0%B4%B6%E0%B4%BE%E0%B4%B8%E0%B5%8D%E0%B4%A4%E0%B5%8D%E0%B4%B0%E0%B4%82)" title="കോമ (വൈദ്യശാസ്ത്രം) – Malayalam" lang="ml" hreflang="ml" data-title="കോമ (വൈദ്യശാസ്ത്രം)" data-language-autonym="മലയാളം" data-language-local-name="Malayalam" class="interlanguage-link-target"><span>മലയാളം</span></a></li><li class="interlanguage-link interwiki-ms mw-list-item"><a href="https://ms.wikipedia.org/wiki/Koma_(perubatan)" title="Koma (perubatan) – Malay" lang="ms" hreflang="ms" data-title="Koma (perubatan)" data-language-autonym="Bahasa Melayu" data-language-local-name="Malay" class="interlanguage-link-target"><span>Bahasa Melayu</span></a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Coma_(geneeskunde)" title="Coma (geneeskunde) – Dutch" lang="nl" hreflang="nl" data-title="Coma (geneeskunde)" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target"><span>Nederlands</span></a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E6%98%8F%E7%9D%A1" title="昏睡 – Japanese" lang="ja" hreflang="ja" data-title="昏睡" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target"><span>日本語</span></a></li><li class="interlanguage-link interwiki-no mw-list-item"><a href="https://no.wikipedia.org/wiki/Koma" title="Koma – Norwegian Bokmål" lang="nb" hreflang="nb" data-title="Koma" data-language-autonym="Norsk bokmål" data-language-local-name="Norwegian Bokmål" class="interlanguage-link-target"><span>Norsk bokmål</span></a></li><li class="interlanguage-link interwiki-nn mw-list-item"><a href="https://nn.wikipedia.org/wiki/Koma" title="Koma – Norwegian Nynorsk" lang="nn" hreflang="nn" data-title="Koma" data-language-autonym="Norsk nynorsk" data-language-local-name="Norwegian Nynorsk" class="interlanguage-link-target"><span>Norsk nynorsk</span></a></li><li class="interlanguage-link interwiki-or mw-list-item"><a href="https://or.wikipedia.org/wiki/%E0%AC%95%E0%AD%8B%E0%AC%AE%E0%AC%BE" title="କୋମା – Odia" lang="or" hreflang="or" data-title="କୋମା" data-language-autonym="ଓଡ଼ିଆ" data-language-local-name="Odia" class="interlanguage-link-target"><span>ଓଡ଼ିଆ</span></a></li><li class="interlanguage-link interwiki-uz mw-list-item"><a href="https://uz.wikipedia.org/wiki/Koma" title="Koma – Uzbek" lang="uz" hreflang="uz" data-title="Koma" data-language-autonym="Oʻzbekcha / ўзбекча" data-language-local-name="Uzbek" class="interlanguage-link-target"><span>Oʻzbekcha / ўзбекча</span></a></li><li class="interlanguage-link interwiki-pa mw-list-item"><a href="https://pa.wikipedia.org/wiki/%E0%A8%95%E0%A9%8B%E0%A8%AE%E0%A8%BE" title="ਕੋਮਾ – Punjabi" lang="pa" hreflang="pa" data-title="ਕੋਮਾ" data-language-autonym="ਪੰਜਾਬੀ" data-language-local-name="Punjabi" class="interlanguage-link-target"><span>ਪੰਜਾਬੀ</span></a></li><li class="interlanguage-link interwiki-ps mw-list-item"><a href="https://ps.wikipedia.org/wiki/%DA%A9%D9%88%D9%85%D8%A7" title="کوما – Pashto" lang="ps" hreflang="ps" data-title="کوما" data-language-autonym="پښتو" data-language-local-name="Pashto" class="interlanguage-link-target"><span>پښتو</span></a></li><li class="interlanguage-link interwiki-jam mw-list-item"><a href="https://jam.wikipedia.org/wiki/Kuoma" title="Kuoma – Jamaican Creole English" lang="jam" hreflang="jam" data-title="Kuoma" data-language-autonym="Patois" data-language-local-name="Jamaican Creole English" class="interlanguage-link-target"><span>Patois</span></a></li><li class="interlanguage-link interwiki-pl mw-list-item"><a href="https://pl.wikipedia.org/wiki/%C5%9Api%C4%85czka" title="Śpiączka – Polish" lang="pl" hreflang="pl" data-title="Śpiączka" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target"><span>Polski</span></a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Coma" title="Coma – Portuguese" lang="pt" hreflang="pt" data-title="Coma" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target"><span>Português</span></a></li><li class="interlanguage-link interwiki-ro mw-list-item"><a href="https://ro.wikipedia.org/wiki/Com%C4%83" title="Comă – Romanian" lang="ro" hreflang="ro" data-title="Comă" data-language-autonym="Română" data-language-local-name="Romanian" class="interlanguage-link-target"><span>Română</span></a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%9A%D0%BE%D0%BC%D0%B0" title="Кома – Russian" lang="ru" hreflang="ru" data-title="Кома" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target"><span>Русский</span></a></li><li class="interlanguage-link interwiki-sah mw-list-item"><a href="https://sah.wikipedia.org/wiki/%D0%9A%D0%BE%D0%BC%D0%B0" title="Кома – Yakut" lang="sah" hreflang="sah" data-title="Кома" data-language-autonym="Саха тыла" data-language-local-name="Yakut" class="interlanguage-link-target"><span>Саха тыла</span></a></li><li class="interlanguage-link interwiki-sq mw-list-item"><a href="https://sq.wikipedia.org/wiki/Koma" title="Koma – Albanian" lang="sq" hreflang="sq" data-title="Koma" data-language-autonym="Shqip" data-language-local-name="Albanian" class="interlanguage-link-target"><span>Shqip</span></a></li><li class="interlanguage-link interwiki-simple mw-list-item"><a href="https://simple.wikipedia.org/wiki/Coma" title="Coma – Simple English" lang="en-simple" hreflang="en-simple" data-title="Coma" data-language-autonym="Simple English" data-language-local-name="Simple English" class="interlanguage-link-target"><span>Simple English</span></a></li><li class="interlanguage-link interwiki-sk mw-list-item"><a href="https://sk.wikipedia.org/wiki/K%C3%B3ma" title="Kóma – Slovak" lang="sk" hreflang="sk" data-title="Kóma" data-language-autonym="Slovenčina" data-language-local-name="Slovak" class="interlanguage-link-target"><span>Slovenčina</span></a></li><li class="interlanguage-link interwiki-sl mw-list-item"><a href="https://sl.wikipedia.org/wiki/Koma" title="Koma – Slovenian" lang="sl" hreflang="sl" data-title="Koma" data-language-autonym="Slovenščina" data-language-local-name="Slovenian" class="interlanguage-link-target"><span>Slovenščina</span></a></li><li class="interlanguage-link interwiki-so mw-list-item"><a href="https://so.wikipedia.org/wiki/Miyir-beel" title="Miyir-beel – Somali" lang="so" hreflang="so" data-title="Miyir-beel" data-language-autonym="Soomaaliga" data-language-local-name="Somali" class="interlanguage-link-target"><span>Soomaaliga</span></a></li><li class="interlanguage-link interwiki-ckb mw-list-item"><a href="https://ckb.wikipedia.org/wiki/%DA%A9%DB%86%D9%85%D8%A7" title="کۆما – Central Kurdish" lang="ckb" hreflang="ckb" data-title="کۆما" data-language-autonym="کوردی" data-language-local-name="Central Kurdish" class="interlanguage-link-target"><span>کوردی</span></a></li><li class="interlanguage-link interwiki-sr mw-list-item"><a href="https://sr.wikipedia.org/wiki/%D0%9A%D0%BE%D0%BC%D0%B0" title="Кома – Serbian" lang="sr" hreflang="sr" data-title="Кома" data-language-autonym="Српски / srpski" data-language-local-name="Serbian" class="interlanguage-link-target"><span>Српски / srpski</span></a></li><li class="interlanguage-link interwiki-sh mw-list-item"><a href="https://sh.wikipedia.org/wiki/Koma" title="Koma – Serbo-Croatian" lang="sh" hreflang="sh" data-title="Koma" data-language-autonym="Srpskohrvatski / српскохрватски" data-language-local-name="Serbo-Croatian" class="interlanguage-link-target"><span>Srpskohrvatski / српскохрватски</span></a></li><li class="interlanguage-link interwiki-fi mw-list-item"><a href="https://fi.wikipedia.org/wiki/Kooma" title="Kooma – Finnish" lang="fi" hreflang="fi" data-title="Kooma" data-language-autonym="Suomi" data-language-local-name="Finnish" class="interlanguage-link-target"><span>Suomi</span></a></li><li class="interlanguage-link interwiki-sv mw-list-item"><a href="https://sv.wikipedia.org/wiki/Koma" title="Koma – Swedish" lang="sv" hreflang="sv" data-title="Koma" data-language-autonym="Svenska" data-language-local-name="Swedish" class="interlanguage-link-target"><span>Svenska</span></a></li><li class="interlanguage-link interwiki-tl mw-list-item"><a href="https://tl.wikipedia.org/wiki/Coma" title="Coma – Tagalog" lang="tl" hreflang="tl" data-title="Coma" data-language-autonym="Tagalog" data-language-local-name="Tagalog" class="interlanguage-link-target"><span>Tagalog</span></a></li><li class="interlanguage-link interwiki-ta mw-list-item"><a href="https://ta.wikipedia.org/wiki/%E0%AE%86%E0%AE%B4%E0%AF%8D%E0%AE%AE%E0%AE%AF%E0%AE%95%E0%AF%8D%E0%AE%95%E0%AE%AE%E0%AF%8D" title="ஆழ்மயக்கம் – Tamil" lang="ta" hreflang="ta" data-title="ஆழ்மயக்கம்" data-language-autonym="தமிழ்" data-language-local-name="Tamil" class="interlanguage-link-target"><span>தமிழ்</span></a></li><li class="interlanguage-link interwiki-tt mw-list-item"><a href="https://tt.wikipedia.org/wiki/%D0%9A%D0%BE%D0%BC%D0%B0" title="Кома – Tatar" lang="tt" hreflang="tt" data-title="Кома" data-language-autonym="Татарча / tatarça" data-language-local-name="Tatar" class="interlanguage-link-target"><span>Татарча / tatarça</span></a></li><li class="interlanguage-link interwiki-th mw-list-item"><a href="https://th.wikipedia.org/wiki/%E0%B9%82%E0%B8%84%E0%B8%A1%E0%B9%88%E0%B8%B2" title="โคม่า – Thai" lang="th" hreflang="th" data-title="โคม่า" data-language-autonym="ไทย" data-language-local-name="Thai" class="interlanguage-link-target"><span>ไทย</span></a></li><li class="interlanguage-link interwiki-tr mw-list-item"><a href="https://tr.wikipedia.org/wiki/Koma" title="Koma – Turkish" lang="tr" hreflang="tr" data-title="Koma" data-language-autonym="Türkçe" data-language-local-name="Turkish" class="interlanguage-link-target"><span>Türkçe</span></a></li><li class="interlanguage-link interwiki-uk mw-list-item"><a href="https://uk.wikipedia.org/wiki/%D0%9A%D0%BE%D0%BC%D0%B0_(%D0%BC%D0%B5%D0%B4%D0%B8%D1%86%D0%B8%D0%BD%D0%B0)" title="Кома (медицина) – Ukrainian" lang="uk" hreflang="uk" data-title="Кома (медицина)" data-language-autonym="Українська" data-language-local-name="Ukrainian" class="interlanguage-link-target"><span>Українська</span></a></li><li class="interlanguage-link interwiki-vi mw-list-item"><a href="https://vi.wikipedia.org/wiki/H%C3%B4n_m%C3%AA" title="Hôn mê – Vietnamese" lang="vi" hreflang="vi" data-title="Hôn mê" 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class="mw-body-content"><div class="mw-content-ltr mw-parser-output" lang="en" dir="ltr"><div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">State of unconsciousness</div> <style data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">Not to be confused with <a href="/wiki/Comma" title="Comma">Comma</a>.</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951" /><div role="note" class="hatnote navigation-not-searchable">For other uses, see <a href="/wiki/Coma_(disambiguation)" class="mw-disambig" title="Coma (disambiguation)">Coma (disambiguation)</a> and <a href="/wiki/Comas_(disambiguation)" class="mw-disambig" title="Comas (disambiguation)">Comas (disambiguation)</a>.</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951" /><div role="note" class="hatnote navigation-not-searchable">"Comatose" redirects here. For other uses, see <a href="/wiki/Comatose_(disambiguation)" class="mw-disambig" title="Comatose (disambiguation)">Comatose (disambiguation)</a>.</div> <p class="mw-empty-elt"> </p> <div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical condition</div><style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox infobox-has-images-with-white-backgrounds"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Coma</th></tr><tr><td colspan="2" class="infobox-full-data"><span class="mw-default-size" typeof="mw:File/Frameless"><a href="/wiki/File:Comaventilator.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/d/d7/Comaventilator.jpg/220px-Comaventilator.jpg" decoding="async" width="220" height="124" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/d/d7/Comaventilator.jpg/330px-Comaventilator.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/d/d7/Comaventilator.jpg/440px-Comaventilator.jpg 2x" data-file-width="1920" data-file-height="1080" /></a></span></td></tr><tr><td colspan="2" class="infobox-full-data">Image of a comatose man unresponsive to stimuli</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Neurology" title="Neurology">Neurology</a>, <a href="/wiki/Psychiatry" title="Psychiatry">psychiatry</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Signs_and_symptoms" title="Signs and symptoms">Symptoms</a></th><td class="infobox-data">Unconsciousness</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Complication_(medicine)" title="Complication (medicine)">Complications</a></th><td class="infobox-data"><a href="/wiki/Persistent_vegetative_state" class="mw-redirect" title="Persistent vegetative state">Persistent vegetative state</a>, <a href="/wiki/Death" title="Death">death</a></td></tr><tr><th scope="row" class="infobox-label">Duration</th><td class="infobox-data">Can vary from a few days to several years</td></tr></tbody></table><style data-mw-deduplicate="TemplateStyles:r1236303919">@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-has-images-with-white-backgrounds img{background:white}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-has-images-with-white-backgrounds img{background:white}}</style> <p>A <b>coma</b> is a deep state of prolonged <a href="/wiki/Unconsciousness" title="Unconsciousness">unconsciousness</a> in which a person cannot be awakened, fails to respond normally to painful <a href="/wiki/Stimulation" title="Stimulation">stimuli</a>, light, or sound, lacks a normal wake–sleep cycle and does not initiate <a href="/wiki/Voluntary_action" title="Voluntary action">voluntary actions</a>.<sup id="cite_ref-RR_1-0" class="reference"><a href="#cite_note-RR-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> The person may experience respiratory and circulatory problems due to the body's inability to maintain normal bodily functions. People in a coma often require extensive medical care to maintain their health and prevent complications such as <a href="/wiki/Pneumonia" title="Pneumonia">pneumonia</a> or <a href="/wiki/Blood_clots" class="mw-redirect" title="Blood clots">blood clots</a>.<sup id="cite_ref-Huff_Tadi_Coma_2-0" class="reference"><a href="#cite_note-Huff_Tadi_Coma-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Coma patients exhibit a complete absence of wakefulness and are unable to consciously feel, speak or move.<sup id="cite_ref-:0_3-0" class="reference"><a href="#cite_note-:0-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-4" class="reference"><a href="#cite_note-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> Comas can be the result of natural causes, or can be <a href="/wiki/Induced_coma" title="Induced coma">medically induced</a>.<sup id="cite_ref-5" class="reference"><a href="#cite_note-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> </p><p>Clinically, a coma can be defined as the consistent inability to follow a one-step command.<sup id="cite_ref-6" class="reference"><a href="#cite_note-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-7" class="reference"><a href="#cite_note-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> For a patient to maintain consciousness, the components of <i>wakefulness</i> and <i>awareness</i> must be maintained. <a href="/wiki/Wakefulness" title="Wakefulness">Wakefulness</a> is a quantitative assessment of the degree of <a href="/wiki/Consciousness" title="Consciousness">consciousness</a>, whereas <a href="/wiki/Awareness" title="Awareness">awareness</a> is a qualitative assessment of the functions mediated by the cortex, including cognitive abilities such as attention, sensory perception, explicit memory, language, the execution of tasks, temporal and spatial orientation and reality judgment.<sup id="cite_ref-:0_3-1" class="reference"><a href="#cite_note-:0-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-8" class="reference"><a href="#cite_note-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> Neurologically, consciousness is maintained by the activation of the <a href="/wiki/Cerebral_cortex" title="Cerebral cortex">cerebral cortex</a>—the <a href="/wiki/Gray_matter" class="mw-redirect" title="Gray matter">gray matter</a> that forms the brain's outermost layer—and by the <a href="/wiki/Reticular_activating_system" class="mw-redirect" title="Reticular activating system">reticular activating system</a> (RAS), a structure in the <a href="/wiki/Brainstem" title="Brainstem">brainstem</a>.<sup id="cite_ref-med_9-0" class="reference"><a href="#cite_note-med-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-10" class="reference"><a href="#cite_note-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Etymology">Etymology</h2></div> <p>The term 'coma', from the Greek <span title="Ancient Greek (to 1453)-language text"><span lang="grc">κῶμα</span></span> <i>koma</i>, meaning deep sleep, had already been used in the <a href="/wiki/Hippocratic_Corpus" title="Hippocratic Corpus">Hippocratic corpus</a> (<i>Epidemica</i>) and later by <a href="/wiki/Galen" title="Galen">Galen</a> (second century AD). Subsequently, it was hardly used in the known literature up to the middle of the 17th century. The term is found again in <a href="/wiki/Thomas_Willis" title="Thomas Willis">Thomas Willis</a>' (1621–1675) influential <i>De anima brutorum</i> (1672), where <a href="/wiki/Lethargy" title="Lethargy">lethargy</a> (pathological sleep), 'coma' (heavy sleeping), <i>carus</i> (deprivation of the senses) and <a href="/wiki/Apoplexy" title="Apoplexy">apoplexy</a> (into which <i>carus</i> could turn and which he localized in the <a href="/wiki/White_matter" title="White matter">white matter</a>) are mentioned. The term <i>carus</i> is also derived from Greek, where it can be found in the roots of several words meaning soporific or sleepy. It can still be found in the root of the term 'carotid'. <a href="/wiki/Thomas_Sydenham" title="Thomas Sydenham">Thomas Sydenham</a> (1624–89) mentioned the term 'coma' in several cases of fever (Sydenham, 1685).<sup id="cite_ref-11" class="reference"><a href="#cite_note-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-12" class="reference"><a href="#cite_note-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Signs_and_symptoms">Signs and symptoms</h2></div> <p>General symptoms of a person in a comatose state are: </p> <ul><li>Inability to voluntarily open the eyes</li> <li>A nonexistent sleep–wake cycle</li> <li>Lack of response to physical (painful) or verbal stimuli</li> <li>Depressed brainstem reflexes, such as pupils not responding to light</li> <li>Abnormal, difficulty, or irregular breathing or no breathing at all when coma was caused by <a href="/wiki/Cardiac_arrest" title="Cardiac arrest">cardiac arrest</a></li> <li>Scores between 3 and 8<sup id="cite_ref-13" class="reference"><a href="#cite_note-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> on the <a href="/wiki/Glasgow_Coma_Scale" title="Glasgow Coma Scale">Glasgow Coma Scale</a><sup id="cite_ref-RR_1-1" class="reference"><a href="#cite_note-RR-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup></li></ul> <div class="mw-heading mw-heading2"><h2 id="Causes">Causes</h2></div> <p>Many types of problems can cause a coma. Forty percent of comatose states result from <a href="/wiki/Drug_poisoning" class="mw-redirect" title="Drug poisoning">drug poisoning</a>.<sup id="cite_ref-Liversedge_2010_337–339_14-0" class="reference"><a href="#cite_note-Liversedge_2010_337–339-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> Certain drug use under certain conditions can damage or weaken the <a href="/wiki/Synaptic_vesicle" title="Synaptic vesicle">synaptic</a> functioning in the <a href="/wiki/Reticular_formation" title="Reticular formation">ascending reticular activating system</a> (ARAS) and keep the system from properly functioning to arouse the brain.<sup id="cite_ref-Young_2009_32–47_15-0" class="reference"><a href="#cite_note-Young_2009_32–47-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> Secondary effects of drugs, which include abnormal heart rate and blood pressure, as well as abnormal breathing and sweating, may also indirectly harm the functioning of the ARAS and lead to a coma. Given that drug poisoning is the cause for a large portion of patients in a coma, hospitals first test all comatose patients by observing pupil size and eye movement, through the <a href="/wiki/Vestibulo-ocular_reflex" title="Vestibulo-ocular reflex">vestibular–ocular reflex</a>. (See <i>Diagnosis</i> below.)<sup id="cite_ref-Young_2009_32–47_15-1" class="reference"><a href="#cite_note-Young_2009_32–47-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> </p><p>The second most common cause of coma, which makes up about 25% of cases, is lack of oxygen, generally resulting from <a href="/wiki/Cardiac_arrest" title="Cardiac arrest">cardiac arrest</a>.<sup id="cite_ref-Liversedge_2010_337–339_14-1" class="reference"><a href="#cite_note-Liversedge_2010_337–339-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> The <a href="/wiki/Central_nervous_system" title="Central nervous system">central nervous system (CNS)</a> requires a great deal of oxygen for its <a href="/wiki/Neurons" class="mw-redirect" title="Neurons">neurons</a>. Oxygen deprivation in the <a href="/wiki/Human_brain" title="Human brain">brain</a>, or <i><a href="/wiki/Cerebral_hypoxia" title="Cerebral hypoxia">cerebral hypoxia</a></i>, causes sodium and calcium from outside of the <a href="/wiki/Neuron" title="Neuron">neurons</a> to decrease and intracellular calcium to increase, which harms neuron communication.<sup id="cite_ref-16" class="reference"><a href="#cite_note-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> Lack of oxygen in the brain also causes <a href="/wiki/Adenosine_triphosphate" title="Adenosine triphosphate">ATP</a> exhaustion and cellular breakdown from cytoskeleton damage and <a href="/wiki/Nitric_oxide" title="Nitric oxide">nitric oxide</a> production.<sup id="cite_ref-17" class="reference"><a href="#cite_note-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> </p><p>Twenty percent of comatose states result from an ischemic stroke, brain hemorrhage, or brain tumor.<sup id="cite_ref-Liversedge_2010_337–339_14-2" class="reference"><a href="#cite_note-Liversedge_2010_337–339-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> During a stroke, blood flow to part of the brain is restricted or blocked. An <a href="/wiki/Ischemic_stroke" class="mw-redirect" title="Ischemic stroke">ischemic stroke</a>, <a href="/wiki/Intracerebral_hemorrhage" title="Intracerebral hemorrhage">brain hemorrhage</a>, or brain tumor may cause restriction of blood flow. Lack of blood to cells in the brain prevents oxygen from getting to the neurons, and consequently causes cells to become disrupted and die. As brain cells die, brain tissue continues to deteriorate, which may affect the functioning of the ARAS, causing unconsciousness and coma.<sup id="cite_ref-18" class="reference"><a href="#cite_note-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> </p><p>Comatose cases can also result from <a href="/wiki/Traumatic_brain_injury" title="Traumatic brain injury">traumatic brain injury</a>, excessive <a href="/wiki/Blood_loss" class="mw-redirect" title="Blood loss">blood loss</a>, <a href="/wiki/Malnutrition" title="Malnutrition">malnutrition</a>, <a href="/wiki/Hypothermia" title="Hypothermia">hypothermia</a>, <a href="/wiki/Hyperthermia" title="Hyperthermia">hyperthermia</a>, <a href="/wiki/Hyperammonemia" title="Hyperammonemia">hyperammonemia</a>,<sup id="cite_ref-19" class="reference"><a href="#cite_note-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> abnormal glucose levels, and many other biological disorders. Furthermore, studies show that 1 out of 8 patients with traumatic brain injury experience a comatose state.<sup id="cite_ref-20" class="reference"><a href="#cite_note-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> </p><p>Heart-related causes of coma include <a href="/wiki/Cardiac_arrest" title="Cardiac arrest">cardiac arrest</a>, <a href="/wiki/Ventricular_fibrillation" title="Ventricular fibrillation">ventricular fibrillation</a>, <a href="/wiki/Ventricular_tachycardia" title="Ventricular tachycardia">ventricular tachycardia</a>, <a href="/wiki/Atrial_fibrillation" title="Atrial fibrillation">atrial fibrillation</a>, <a href="/wiki/Myocardial_infarction" title="Myocardial infarction">myocardial infarction</a>, <a href="/wiki/Heart_failure" title="Heart failure">heart failure</a>, <a href="/wiki/Arrhythmia" title="Arrhythmia">arrhythmia</a> when severe, <a href="/wiki/Cardiogenic_shock" title="Cardiogenic shock">cardiogenic shock</a>, <a href="/wiki/Myocarditis" title="Myocarditis">myocarditis</a>, and <a href="/wiki/Pericarditis" title="Pericarditis">pericarditis</a>. <a href="/wiki/Respiratory_arrest" title="Respiratory arrest">Respiratory arrest</a> is the only lung condition to cause coma, but many different lung conditions can cause <a href="/wiki/Decreased_level_of_consciousness" class="mw-redirect" title="Decreased level of consciousness">decreased level of consciousness</a>, but do not reach coma. </p><p>Other causes of coma include <a href="/wiki/Epilepsy" title="Epilepsy">severe or persistent seizures</a>, <a href="/wiki/Kidney_failure" title="Kidney failure">kidney failure</a>, <a href="/wiki/Liver_failure" title="Liver failure">liver failure</a>, <a href="/wiki/Hyperglycemia" title="Hyperglycemia">hyperglycemia</a>, <a href="/wiki/Hypoglycemia" title="Hypoglycemia">hypoglycemia</a>, and infections involving the brain, like <a href="/wiki/Meningitis" title="Meningitis">meningitis</a> and <a href="/wiki/Encephalitis" title="Encephalitis">encephalitis</a>. </p> <div class="mw-heading mw-heading2"><h2 id="Pathophysiology">Pathophysiology</h2></div> <p>Injury to either or both of the <a href="/wiki/Cerebral_cortex" title="Cerebral cortex">cerebral cortex</a> or the <a href="/wiki/Reticular_activating_system" class="mw-redirect" title="Reticular activating system">reticular activating system</a> (RAS) is sufficient to cause a person to enter coma.<sup id="cite_ref-21" class="reference"><a href="#cite_note-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> </p><p>The <a href="/wiki/Cerebral_cortex" title="Cerebral cortex">cerebral cortex</a> is the outer layer of <a href="/wiki/Neural_tissue" class="mw-redirect" title="Neural tissue">neural tissue</a> of the <a href="/wiki/Cerebrum" title="Cerebrum">cerebrum</a> of the <a href="/wiki/Brain" title="Brain">brain</a>.<sup id="cite_ref-22" class="reference"><a href="#cite_note-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> The cerebral cortex is composed of <a href="/wiki/Grey_matter" title="Grey matter">gray matter</a> which consists of the <a href="/wiki/Nucleus_(neuroanatomy)" title="Nucleus (neuroanatomy)">nuclei</a> of <a href="/wiki/Neuron" title="Neuron">neurons</a>, whereas the inner portion of the <a href="/wiki/Cerebrum" title="Cerebrum">cerebrum</a> is composed of <a href="/wiki/White_matter" title="White matter">white matter</a> and is composed of the <a href="/wiki/Axon" title="Axon">axons</a> of <a href="/wiki/Neuron" title="Neuron">neuron</a>.<sup id="cite_ref-23" class="reference"><a href="#cite_note-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> White matter is responsible for <a href="/wiki/Perception" title="Perception">perception</a>, relay of the sensory input via the thalamic pathway, and many other neurological functions, including complex thinking. </p><p>The RAS, on the other hand, is a more primitive structure in the <a href="/wiki/Brainstem" title="Brainstem">brainstem</a> which includes the <a href="/wiki/Reticular_formation" title="Reticular formation">reticular formation</a> (RF).<sup id="cite_ref-Arguinchona_Neuroanatomy_24-0" class="reference"><a href="#cite_note-Arguinchona_Neuroanatomy-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> The RAS has two tracts, the ascending and descending tract. The ascending tract, or ascending reticular activating system (ARAS), is made up of a system of acetylcholine-producing neurons, and works to arouse and wake up the brain.<sup id="cite_ref-25" class="reference"><a href="#cite_note-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> Arousal of the brain begins from the RF, through the <a href="/wiki/Thalamus" title="Thalamus">thalamus</a>, and then finally to the cerebral cortex.<sup id="cite_ref-Young_2009_32–47_15-2" class="reference"><a href="#cite_note-Young_2009_32–47-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> Any impairment in ARAS functioning, a neuronal dysfunction, along the arousal pathway stated directly above, prevents the body from being aware of its surroundings.<sup id="cite_ref-Arguinchona_Neuroanatomy_24-1" class="reference"><a href="#cite_note-Arguinchona_Neuroanatomy-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> Without the arousal and consciousness centers, the body cannot awaken, remaining in a comatose state.<sup id="cite_ref-Traub_2016_777–793_26-0" class="reference"><a href="#cite_note-Traub_2016_777–793-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> </p><p>The severity and mode of onset of coma depends on the underlying cause. There are two main subdivisions of a coma: structural and diffuse neuronal.<sup id="cite_ref-Huff_Tadi_Coma_2-1" class="reference"><a href="#cite_note-Huff_Tadi_Coma-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> A structural cause, for example, is brought upon by a mechanical force that brings about cellular damage, such as physical pressure or a blockage in neural transmission.<sup id="cite_ref-27" class="reference"><a href="#cite_note-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> By contrast, a diffuse cause is limited to aberrations of cellular function which fall under a metabolic or toxic subgroup. Toxin-induced comas are caused by extrinsic substances, whereas metabolic-induced comas are caused by intrinsic processes, such as body thermoregulation or ionic imbalances (e.g. sodium).<sup id="cite_ref-Traub_2016_777–793_26-1" class="reference"><a href="#cite_note-Traub_2016_777–793-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> For instance, severe <a href="/wiki/Hypoglycemia" title="Hypoglycemia">hypoglycemia</a> (low blood sugar) or <a href="/wiki/Hypercapnia" title="Hypercapnia">hypercapnia</a> (increased <a href="/wiki/Carbon_dioxide" title="Carbon dioxide">carbon dioxide</a> levels in the blood) are examples of a metabolic diffuse neuronal dysfunction. Hypoglycemia or hypercapnia initially cause mild agitation and confusion, but progress to <a href="/wiki/Obtundation" title="Obtundation">obtundation</a>, stupor, and finally, complete <a href="/wiki/Unconsciousness" title="Unconsciousness">unconsciousness</a>.<sup id="cite_ref-28" class="reference"><a href="#cite_note-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> In contrast, coma resulting from a severe <a href="/wiki/Traumatic_brain_injury" title="Traumatic brain injury">traumatic brain injury</a> or <a href="/wiki/Subarachnoid_hemorrhage" title="Subarachnoid hemorrhage">subarachnoid hemorrhage</a> can be instantaneous. The mode of onset may therefore be indicative of the underlying cause.<sup id="cite_ref-RR_1-2" class="reference"><a href="#cite_note-RR-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> </p><p>Structural and diffuse causes of coma are not isolated from one another, as one can lead to the other in some situations. For instance, coma induced by a diffuse metabolic process, such as hypoglycemia, can result in a structural coma if it is not resolved. Another example is if cerebral edema, a diffuse dysfunction, leads to ischemia of the brainstem, a structural issue, due to the blockage of the circulation in the brain.<sup id="cite_ref-Traub_2016_777–793_26-2" class="reference"><a href="#cite_note-Traub_2016_777–793-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Diagnosis">Diagnosis</h2></div> <p>Although diagnosis of coma is simple, investigating the underlying cause of onset can be rather challenging. As such, after gaining stabilization of the patient's airways, breathing and circulation (the basic <a href="/wiki/ABC_(medicine)" title="ABC (medicine)">ABCs</a>) various diagnostic tests, such as physical examinations and imaging tools (<a href="/wiki/CT_scan" title="CT scan">CT scan</a>, <a href="/wiki/MRI" class="mw-redirect" title="MRI">MRI</a>, etc.) are employed to access the underlying cause of the coma.<sup id="cite_ref-29" class="reference"><a href="#cite_note-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> </p><p>When an unconscious person enters a hospital, the hospital utilizes a series of diagnostic steps to identify the cause of <a href="/wiki/Unconsciousness" title="Unconsciousness">unconsciousness</a>.<sup id="cite_ref-30" class="reference"><a href="#cite_note-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> According to Young,<sup id="cite_ref-Young_2009_32–47_15-3" class="reference"><a href="#cite_note-Young_2009_32–47-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> the following steps should be taken when dealing with a patient possibly in a coma: </p> <ol><li>Perform a general examination and medical history check</li> <li>Make sure the patient is in an actual comatose state and is not in a <a href="/wiki/Locked-in_syndrome" title="Locked-in syndrome">locked-in state</a> or experiencing psychogenic unresponsiveness. Patients with <a href="/wiki/Locked-in_syndrome" title="Locked-in syndrome">locked-in syndrome</a> present with voluntary movement of their eyes, whereas patients with <a href="/w/index.php?title=Psychogenic_coma&action=edit&redlink=1" class="new" title="Psychogenic coma (page does not exist)">psychogenic comas</a> demonstrate active resistance to passive opening of the eyelids, with the eyelids closing abruptly and completely when the lifted upper eyelid is released (rather than slowly, asymmetrically and incompletely as seen in comas due to organic causes).<sup id="cite_ref-31" class="reference"><a href="#cite_note-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup></li> <li>Find the site of the brain that may be causing coma (e.g., <a href="/wiki/Brainstem" title="Brainstem">brainstem</a>, back of brain...) and assess the severity of the coma with the <a href="/wiki/Glasgow_Coma_Scale" title="Glasgow Coma Scale">Glasgow Coma Scale</a></li> <li>Take blood work to see if drugs were involved or if it was a result of <a href="/wiki/Hypoventilation" title="Hypoventilation">hypoventilation</a>/<a href="/wiki/Hyperventilation" title="Hyperventilation">hyperventilation</a></li> <li>Check for levels of serum glucose, calcium, sodium, potassium, magnesium, phosphate, urea, and creatinine</li> <li>Perform brain scans to observe any abnormal brain functioning using either <a href="/wiki/CT_scan" title="CT scan">CT</a> or <a href="/wiki/Magnetic_resonance_imaging" title="Magnetic resonance imaging">MRI</a> scans</li> <li>Continue to monitor brain waves and identify <a href="/wiki/Epileptic_seizure" class="mw-redirect" title="Epileptic seizure">seizures</a> of patient using <a href="/wiki/Electroencephalography" title="Electroencephalography">EEGs</a></li></ol> <div class="mw-heading mw-heading3"><h3 id="Initial_evaluation">Initial evaluation</h3></div> <style data-mw-deduplicate="TemplateStyles:r1251242444">.mw-parser-output .ambox{border:1px solid #a2a9b1;border-left:10px solid #36c;background-color:#fbfbfb;box-sizing:border-box}.mw-parser-output .ambox+link+.ambox,.mw-parser-output .ambox+link+style+.ambox,.mw-parser-output .ambox+link+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+style+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+link+.ambox{margin-top:-1px}html body.mediawiki .mw-parser-output .ambox.mbox-small-left{margin:4px 1em 4px 0;overflow:hidden;width:238px;border-collapse:collapse;font-size:88%;line-height:1.25em}.mw-parser-output .ambox-speedy{border-left:10px solid #b32424;background-color:#fee7e6}.mw-parser-output .ambox-delete{border-left:10px solid #b32424}.mw-parser-output .ambox-content{border-left:10px solid #f28500}.mw-parser-output .ambox-style{border-left:10px solid #fc3}.mw-parser-output .ambox-move{border-left:10px solid #9932cc}.mw-parser-output .ambox-protection{border-left:10px solid #a2a9b1}.mw-parser-output .ambox .mbox-text{border:none;padding:0.25em 0.5em;width:100%}.mw-parser-output .ambox .mbox-image{border:none;padding:2px 0 2px 0.5em;text-align:center}.mw-parser-output .ambox .mbox-imageright{border:none;padding:2px 0.5em 2px 0;text-align:center}.mw-parser-output .ambox .mbox-empty-cell{border:none;padding:0;width:1px}.mw-parser-output .ambox .mbox-image-div{width:52px}@media(min-width:720px){.mw-parser-output .ambox{margin:0 10%}}@media print{body.ns-0 .mw-parser-output .ambox{display:none!important}}</style><table class="box-More_citations_needed_section plainlinks metadata ambox ambox-content ambox-Refimprove" role="presentation"><tbody><tr><td class="mbox-image"><div class="mbox-image-div"><span typeof="mw:File"><a href="/wiki/File:Question_book-new.svg" class="mw-file-description"><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/9/99/Question_book-new.svg/50px-Question_book-new.svg.png" decoding="async" width="50" height="39" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/9/99/Question_book-new.svg/75px-Question_book-new.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/9/99/Question_book-new.svg/100px-Question_book-new.svg.png 2x" data-file-width="512" data-file-height="399" /></a></span></div></td><td class="mbox-text"><div class="mbox-text-span">This section <b>needs additional citations for <a href="/wiki/Wikipedia:Verifiability" title="Wikipedia:Verifiability">verification</a></b>.<span class="hide-when-compact"> Please help <a href="/wiki/Special:EditPage/Coma" title="Special:EditPage/Coma">improve this article</a> by <a href="/wiki/Help:Referencing_for_beginners" title="Help:Referencing for beginners">adding citations to reliable sources</a> in this section. Unsourced material may be challenged and removed.</span> <span class="date-container"><i>(<span class="date">August 2020</span>)</i></span><span class="hide-when-compact"><i> (<small><a href="/wiki/Help:Maintenance_template_removal" title="Help:Maintenance template removal">Learn how and when to remove this message</a></small>)</i></span></div></td></tr></tbody></table> <p>In the initial assessment of coma, it is common to gauge the <a href="/wiki/Level_of_consciousness" class="mw-redirect" title="Level of consciousness">level of consciousness</a> on the <a href="/wiki/AVPU" title="AVPU">AVPU</a> (alert, vocal stimuli, painful stimuli, unresponsive) scale by spontaneously exhibiting actions and, assessing the patient's response to vocal and painful stimuli.<sup id="cite_ref-32" class="reference"><a href="#cite_note-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> More elaborate scales, such as the <a href="/wiki/Glasgow_Coma_Scale" title="Glasgow Coma Scale">Glasgow Coma Scale</a>, quantify an individual's reactions such as eye opening, movement and verbal response in order to indicate their extent of brain injury.<sup id="cite_ref-33" class="reference"><a href="#cite_note-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> The patient's score can vary from a score of 3 (indicating severe brain injury and death) to 15 (indicating mild or no brain injury).<sup id="cite_ref-34" class="reference"><a href="#cite_note-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> </p><p>In those with deep unconsciousness, there is a risk of <a href="/wiki/Asphyxiation" class="mw-redirect" title="Asphyxiation">asphyxiation</a> as the control over the muscles in the face and throat is diminished. As a result, those presenting to a hospital with coma are typically assessed for this risk ("<a href="/wiki/Airway_management" title="Airway management">airway management</a>"). If the risk of asphyxiation is deemed high, doctors may use various devices (such as an <a href="/wiki/Oropharyngeal_airway" title="Oropharyngeal airway">oropharyngeal airway</a>, <a href="/wiki/Nasopharyngeal_airway" title="Nasopharyngeal airway">nasopharyngeal airway</a> or <a href="/wiki/Endotracheal_tube" class="mw-redirect" title="Endotracheal tube">endotracheal tube</a>) to safeguard the airway. </p> <div class="mw-heading mw-heading3"><h3 id="Imaging_and_testing">Imaging and testing</h3></div> <p>Imaging encompasses <a href="/wiki/CT_scan" title="CT scan">computed tomography</a> (CAT or CT) scan of the brain, or <a href="/wiki/MRI" class="mw-redirect" title="MRI">MRI</a> for example, and is performed to identify specific causes of the coma, such as <a href="/wiki/Hemorrhage" class="mw-redirect" title="Hemorrhage">hemorrhage</a> in the brain or <a href="/wiki/Herniation" class="mw-redirect" title="Herniation">herniation</a> of the brain structures.<sup id="cite_ref-Haupt_Coma_and_cerebral_imaging_35-0" class="reference"><a href="#cite_note-Haupt_Coma_and_cerebral_imaging-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup> Special tests such as an <a href="/wiki/EEG" class="mw-redirect" title="EEG">EEG</a> can also show a lot about the activity level of the cortex such as semantic processing,<sup id="cite_ref-Daltrozzo01_36-0" class="reference"><a href="#cite_note-Daltrozzo01-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup> presence of <a href="/wiki/Seizures" class="mw-redirect" title="Seizures">seizures</a>, and are important available tools not only for the assessment of the cortical activity but also for predicting the likelihood of the patient's awakening.<sup id="cite_ref-Daltrozzo02_37-0" class="reference"><a href="#cite_note-Daltrozzo02-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup> The autonomous responses such as the <a href="/wiki/Skin_conductance_response" class="mw-redirect" title="Skin conductance response">skin conductance response</a> may also provide further insight on the patient's emotional processing.<sup id="cite_ref-Daltrozzo03_38-0" class="reference"><a href="#cite_note-Daltrozzo03-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup> </p><p>In the treatment of traumatic brain injury (TBI), there are 4 examination methods that have proved useful: skull x-ray, angiography, computed tomography (CT), and magnetic resonance imaging (MRI).<sup id="cite_ref-39" class="reference"><a href="#cite_note-39"><span class="cite-bracket">[</span>39<span class="cite-bracket">]</span></a></sup> The skull x-ray can detect linear fractures, impression fractures (expression fractures) and burst fractures.<sup id="cite_ref-40" class="reference"><a href="#cite_note-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> Angiography is used on rare occasions for TBIs i.e. when there is suspicion of an aneurysm, carotid sinus fistula, traumatic vascular occlusion, and vascular dissection.<sup id="cite_ref-41" class="reference"><a href="#cite_note-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup> A CT can detect changes in density between the brain tissue and hemorrhages like subdural and intracerebral hemorrhages. MRIs are not the first choice in emergencies because of the long scanning times and because fractures cannot be detected as well as CT. MRIs are used for the imaging of soft tissues and lesions in the posterior fossa which cannot be found with the use of CT.<sup id="cite_ref-Haupt_Coma_and_cerebral_imaging_35-1" class="reference"><a href="#cite_note-Haupt_Coma_and_cerebral_imaging-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Body_movements">Body movements</h3></div> <p>Assessment of the brainstem and cortical function through special reflex tests such as the <a href="/wiki/Oculocephalic_reflex" class="mw-redirect" title="Oculocephalic reflex">oculocephalic reflex</a> test (doll's eyes test), <a href="/wiki/Vestibulo-ocular_reflex" title="Vestibulo-ocular reflex">oculovestibular reflex</a> test (cold caloric test), <a href="/wiki/Corneal_reflex" title="Corneal reflex">corneal reflex</a>, and the <a href="/wiki/Gag_reflex" class="mw-redirect" title="Gag reflex">gag reflex</a>.<sup id="cite_ref-42" class="reference"><a href="#cite_note-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup> Reflexes are a good indicator of what <a href="/wiki/Cranial_nerves" title="Cranial nerves">cranial nerves</a> are still intact and functioning and is an important part of the physical exam. Due to the unconscious status of the patient, only a limited number of the nerves can be assessed. These include the cranial nerves number 2 (CN II), number 3 (CN III), number 5 (CN V), number 7 (CN VII), and cranial nerves 9 and 10 (CN IX, CN X). </p> <table class="wikitable"> <tbody><tr> <th>Type of reflex </th> <th>Description </th></tr> <tr> <td><a href="/wiki/Oculocephalic_reflex" class="mw-redirect" title="Oculocephalic reflex">Oculocephalic reflex</a> </td> <td>Oculocephalic reflex, also known as the doll's eye, is performed to assess the integrity of the brainstem. <ul><li>Patient's eyelids are gently elevated and the cornea is visualized.</li> <li>The patient's head is then moved to the patient's left, to observe whether the eyes stay or deviate toward the patient's right; same maneuver is attempted on the opposite side.</li> <li>If the patient's eyes move in a direction opposite to the direction of the rotation of the head, then the patient is said to have an intact brainstem.</li> <li>However, failure of both eyes to move to one side can indicate damage or destruction of the affected side. In special cases, where only one eye deviates and the other does not, this often indicates a lesion (or damage) of the <a href="/wiki/Medial_longitudinal_fasciculus" title="Medial longitudinal fasciculus">medial longitudinal fasciculus</a> (MLF), which is a brainstem nerve tract.</li></ul> </td></tr> <tr> <td><a href="/wiki/Pupillary_light_reflex" title="Pupillary light reflex">Pupillary light reflex</a> </td> <td>Pupil reaction to light is important because it shows an intact retina, and cranial nerve number 2 (CN II) <ul><li>If pupils are reactive to light, then that also indicates that the cranial nerve number 3 (CN III) (or at least its <a href="/wiki/Parasympathetic" class="mw-redirect" title="Parasympathetic">parasympathetic</a> fibers) are intact.</li></ul> </td></tr> <tr> <td><a href="/wiki/Caloric_reflex_test" title="Caloric reflex test">Oculovestibular reflex<br />(Cold Caloric Test)</a> </td> <td>Caloric reflex test also evaluates both cortical and brainstem function <ul><li>Cold water is injected into one ear and the patient is observed for eye movement</li> <li>If the patient's eyes slowly deviate toward the ear where the water was injected, then the brainstem is intact, however failure to deviate toward the injected ear indicates damage of the brainstem on that side.</li> <li>The cortex is responsible for a rapid <a href="/wiki/Nystagmus" title="Nystagmus">nystagmus</a> away from this deviated position and is often seen in patients who are conscious or merely lethargic.</li></ul> </td></tr> <tr> <td><a href="/wiki/Corneal_reflex" title="Corneal reflex">Corneal reflex</a> </td> <td>The corneal reflex assesses the proper function of the <a href="/wiki/Trigeminal_nerve" title="Trigeminal nerve">trigeminal nerve</a> (CN 5) and <a href="/wiki/Facial_nerve" title="Facial nerve">facial nerve</a> (CN 7), and is present at infancy. <ul><li>Lightly touching the <a href="/wiki/Cornea" title="Cornea">cornea</a> with a tissue or cotton swab induces a rapid blink reflex of both eyes.</li> <li>Touching the sclera or eyelashes, presenting a light flash, or stimulating the <a href="/wiki/Supraorbital_nerve" title="Supraorbital nerve">supraorbital nerve</a> will induce a less rapid but still reliable response.</li> <li>Those in a comatose state will have altered corneal reflex depending on the severity of their unconscious and the location of their lesion.<sup id="cite_ref-43" class="reference"><a href="#cite_note-43"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup></li></ul> </td></tr> <tr> <td><a href="/wiki/Gag_reflex" class="mw-redirect" title="Gag reflex">Gag reflex</a> </td> <td>The gag, or pharyngeal, reflex is centered in the medulla and consists of the reflexive motor response of pharyngeal elevation and constriction with tongue retraction in response to sensory stimulation of the pharyngeal wall, posterior tongue, <a href="/wiki/Tonsil" title="Tonsil">tonsils</a>, or faucial pillars. <ul><li>This reflex is examined by touching the posterior <a href="/wiki/Pharynx" title="Pharynx">pharynx</a> with the soft tip of a cotton applicator and visually inspecting for elevation of the pharynx.</li> <li>Those in comatose states will often demonstrate poor gag reflexes if there has been damage to their glossopharyngeal (CN 9) or vagus nerve (CN 10).<sup id="cite_ref-44" class="reference"><a href="#cite_note-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup></li></ul> </td></tr></tbody></table> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Decorticate.PNG" class="mw-file-description"><img alt="Illustration of characteristic pose laying face-up, arms bent with knuckles held together at sternum, legs together and straight" src="//upload.wikimedia.org/wikipedia/commons/thumb/2/2a/Decorticate.PNG/220px-Decorticate.PNG" decoding="async" width="220" height="52" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/2/2a/Decorticate.PNG/330px-Decorticate.PNG 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/2/2a/Decorticate.PNG/440px-Decorticate.PNG 2x" data-file-width="574" data-file-height="136" /></a><figcaption><a href="/wiki/Decorticate_posturing" class="mw-redirect" title="Decorticate posturing">Decorticate posturing</a>, indicating a <a href="/wiki/Lesion" title="Lesion">lesion</a> at the <a href="/wiki/Red_nucleus" title="Red nucleus">red nucleus</a> or above. This positioning is stereotypical for upper <a href="/wiki/Brain_stem" class="mw-redirect" title="Brain stem">brain stem</a>, or <a href="/wiki/Cortex_(anatomy)" title="Cortex (anatomy)">cortical</a> damage. The other variant is <a href="/wiki/Decerebrate_posturing" class="mw-redirect" title="Decerebrate posturing">decerebrate posturing</a>, not seen in this picture.</figcaption></figure> <p>Assessment of posture and physique is the next step. It involves general observation about the patient's positioning. There are often two stereotypical postures seen in comatose patients. <a href="/wiki/Decorticate_posturing" class="mw-redirect" title="Decorticate posturing">Decorticate posturing</a> is a stereotypical posturing in which the patient has arms <a href="/wiki/Flexion" class="mw-redirect" title="Flexion">flexed</a> at the elbow, and arms adducted toward the body, with both legs <a href="/wiki/Extension_(kinesiology)" class="mw-redirect" title="Extension (kinesiology)">extended</a>. <a href="/wiki/Decerebrate_posturing" class="mw-redirect" title="Decerebrate posturing">Decerebrate posturing</a> is a stereotypical posturing in which the legs are similarly extended (stretched), but the arms are also stretched (extended at the elbow). The posturing is critical since it indicates where the damage is in the central nervous system. A decorticate posturing indicates a lesion (a point of damage) at or above the <a href="/wiki/Red_nucleus" title="Red nucleus">red nucleus</a>, whereas a decerebrate posturing indicates a lesion at or below the red nucleus. In other words, a decorticate lesion is closer to the <a href="/wiki/Cortex_(anatomy)" title="Cortex (anatomy)">cortex</a>, as opposed to a decerebrate posturing which indicates that the lesion is closer to the <a href="/wiki/Brainstem" title="Brainstem">brainstem</a>. </p> <div class="mw-heading mw-heading3"><h3 id="Pupil_size">Pupil size</h3></div> <p>Pupil assessment is often a critical portion of a comatose examination, as it can give information as to the cause of the coma; the following table is a technical, medical guideline for common pupil findings and their possible interpretations:<sup id="cite_ref-med_9-1" class="reference"><a href="#cite_note-med-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </p> <table class="wikitable"> <tbody><tr> <th>Pupil sizes (left eye vs. right eye)</th> <th>Possible interpretation </th></tr> <tr> <td><span typeof="mw:File"><a href="/wiki/File:Darkblue.jpg" class="mw-file-description"><img alt="Eyes open and pupils equal-dilation, normal size" src="//upload.wikimedia.org/wikipedia/commons/thumb/d/db/Darkblue.jpg/250px-Darkblue.jpg" decoding="async" width="250" height="62" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/d/db/Darkblue.jpg/375px-Darkblue.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/d/db/Darkblue.jpg/500px-Darkblue.jpg 2x" data-file-width="3007" data-file-height="745" /></a></span></td> <td>Normal eye with two pupils equal in size and reactive to light. This means that the patient is probably not in a coma and is probably lethargic, under influence of a drug, or sleeping. </td></tr> <tr> <td><span typeof="mw:File"><a href="/wiki/File:Myosis_due_to_opiate_use.jpg" class="mw-file-description"><img alt="Eyes open, pupils smaller than expected and equal" src="//upload.wikimedia.org/wikipedia/commons/thumb/f/f6/Myosis_due_to_opiate_use.jpg/250px-Myosis_due_to_opiate_use.jpg" decoding="async" width="250" height="61" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/f/f6/Myosis_due_to_opiate_use.jpg/375px-Myosis_due_to_opiate_use.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/f/f6/Myosis_due_to_opiate_use.jpg/500px-Myosis_due_to_opiate_use.jpg 2x" data-file-width="1473" data-file-height="362" /></a></span></td> <td>"Pinpoint" pupils indicate <a href="/wiki/Heroin" title="Heroin">heroin</a> or opiate overdose, which can be responsible for a patient's coma. The pinpoint pupils are still reactive to light <a href="https://en.wiktionary.org/wiki/bilateral" class="extiw" title="wikt:bilateral">bilaterally</a> (in both eyes, not just one). Another possibility is damage to the <a href="/wiki/Pons" title="Pons">pons</a>.<sup id="cite_ref-med_9-2" class="reference"><a href="#cite_note-med-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </td></tr> <tr> <td><span typeof="mw:File"><a href="/wiki/File:Anizokoria.JPG" class="mw-file-description"><img alt="Eyes open, right pupil much larger than left" src="//upload.wikimedia.org/wikipedia/commons/thumb/2/2e/Anizokoria.JPG/250px-Anizokoria.JPG" decoding="async" width="250" height="60" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/2/2e/Anizokoria.JPG/375px-Anizokoria.JPG 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/2/2e/Anizokoria.JPG/500px-Anizokoria.JPG 2x" data-file-width="852" data-file-height="204" /></a></span></td> <td>One pupil is dilated and unreactive, while the other is normal (in this case, the right eye is dilated, while the left eye is normal in size). This could mean damage to the <a href="/wiki/Oculomotor_nerve" title="Oculomotor nerve">oculomotor nerve</a> (cranial nerve number 3, CN III) on the right side, or indicate the possibility of vascular involvement. </td></tr> <tr> <td><span typeof="mw:File"><a href="/wiki/File:Cyclopentolate_1_percent_Pupils.jpg" class="mw-file-description"><img alt="Eyes open, both pupils widely dilated" src="//upload.wikimedia.org/wikipedia/commons/thumb/5/59/Cyclopentolate_1_percent_Pupils.jpg/250px-Cyclopentolate_1_percent_Pupils.jpg" decoding="async" width="250" height="55" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/5/59/Cyclopentolate_1_percent_Pupils.jpg/375px-Cyclopentolate_1_percent_Pupils.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/5/59/Cyclopentolate_1_percent_Pupils.jpg/500px-Cyclopentolate_1_percent_Pupils.jpg 2x" data-file-width="886" data-file-height="194" /></a></span></td> <td>Both pupils are dilated and unreactive to light. This could be due to overdose of certain medications, <a href="/wiki/Hypothermia" title="Hypothermia">hypothermia</a> or severe <a href="/wiki/Hypoxia_(medical)" class="mw-redirect" title="Hypoxia (medical)">anoxia</a> (lack of oxygen). </td></tr></tbody></table> <div class="mw-heading mw-heading3"><h3 id="Severity">Severity</h3></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951" /><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Coma_scale" title="Coma scale">Coma scale</a></div> <p>A coma can be classified as (1) <a href="/wiki/Tentorium_cerebelli" class="mw-redirect" title="Tentorium cerebelli">supratentorial</a> (above <a href="/wiki/Tentorium_cerebelli" class="mw-redirect" title="Tentorium cerebelli">Tentorium cerebelli</a>), (2) <a href="/wiki/Tentorium_cerebelli" class="mw-redirect" title="Tentorium cerebelli">infratentorial</a> (below Tentorium cerebelli), (3) metabolic or (4) diffused.<sup id="cite_ref-med_9-3" class="reference"><a href="#cite_note-med-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> This classification is merely dependent on the position of the original damage that caused the coma, and does not correlate with severity or the prognosis. The severity of coma impairment however is categorized into several levels. Patients may or may not progress through these levels. In the first level, the brain responsiveness lessens, normal reflexes are lost, the patient no longer responds to pain and cannot hear. </p><p>The <a href="/wiki/Rancho_Los_Amigos_Scale" title="Rancho Los Amigos Scale">Rancho Los Amigos Scale</a> is a complex scale that has eight separate levels, and is often used in the first few weeks or months of coma while the patient is under closer observation, and when shifts between levels are more frequent. </p> <div class="mw-heading mw-heading2"><h2 id="Treatment">Treatment</h2></div> <p>Treatment for people in a coma will depend on the severity and cause of the comatose state. Upon admittance to an emergency department, coma patients will usually be placed in an <a href="/wiki/Intensive_care_unit" title="Intensive care unit">Intensive Care Unit</a> (ICU) immediately,<sup id="cite_ref-Young_2009_32–47_15-4" class="reference"><a href="#cite_note-Young_2009_32–47-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> where maintenance of the patient's respiration and circulation become a first priority. Stability of their respiration and circulation is sustained through the use of <a href="/wiki/Tracheal_intubation" title="Tracheal intubation">intubation</a>, <a href="/wiki/Bag_valve_mask" title="Bag valve mask">ventilation</a>, administration of <a href="/wiki/Intravenous_therapy" title="Intravenous therapy">intravenous</a> fluids or blood and other supportive care as needed. </p> <div class="mw-heading mw-heading3"><h3 id="Continued_care">Continued care</h3></div> <p>Once a patient is stable and no longer in immediate danger, there may be a shift of priority from stabilizing the patient to maintaining the state of their physical wellbeing. Moving patients every 2–3 hours by turning them side to side is crucial to avoiding <a href="/wiki/Pressure_ulcer" title="Pressure ulcer">bed sores</a> as a result of being confined to a bed. Moving patients through the use of <a href="/wiki/Physical_therapy" title="Physical therapy">physical therapy</a> also aids in preventing <a href="/wiki/Atelectasis" title="Atelectasis">atelectasis</a>, <a href="/wiki/Contracture" title="Contracture">contractures</a> or other orthopedic deformities which would interfere with a coma patient's recovery.<sup id="cite_ref-sr_45-0" class="reference"><a href="#cite_note-sr-45"><span class="cite-bracket">[</span>45<span class="cite-bracket">]</span></a></sup> </p><p>Pneumonia is also common in coma patients due to their inability to swallow which can then lead to <a href="/wiki/Pulmonary_aspiration" title="Pulmonary aspiration">aspiration</a>. A coma patient's lack of a gag reflex and use of a feeding tube can result in food, drink or other solid organic matter being lodged within their <a href="/wiki/Respiratory_tract" title="Respiratory tract">lower respiratory tract</a> (from the trachea to the lungs). This trapping of matter in their lower respiratory tract can ultimately lead to infection, resulting in <a href="/wiki/Aspiration_pneumonia" title="Aspiration pneumonia">aspiration pneumonia</a>.<sup id="cite_ref-sr_45-1" class="reference"><a href="#cite_note-sr-45"><span class="cite-bracket">[</span>45<span class="cite-bracket">]</span></a></sup> </p><p>Coma patients may also deal with restlessness or seizures. As such, soft cloth restraints may be used to prevent them from pulling on tubes or dressings and side rails on the bed should be kept up to prevent patients from falling.<sup id="cite_ref-sr_45-2" class="reference"><a href="#cite_note-sr-45"><span class="cite-bracket">[</span>45<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Caregivers">Caregivers</h3></div> <p>Coma has a wide variety of emotional reactions from the family members of the affected patients, as well as the primary care givers taking care of the patients. Research has shown that the severity of injury causing coma was found to have no significant impact compared to how much time has passed since the injury occurred.<sup id="cite_ref-46" class="reference"><a href="#cite_note-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup> Common reactions, such as desperation, anger, frustration, and denial are possible. The focus of the patient care should be on creating an amicable relationship with the family members or dependents of a comatose patient as well as creating a rapport with the medical staff.<sup id="cite_ref-47" class="reference"><a href="#cite_note-47"><span class="cite-bracket">[</span>47<span class="cite-bracket">]</span></a></sup> Although there is heavy importance of a primary care taker, secondary care takers can play a supporting role to temporarily relieve the primary care taker's burden of tasks. </p> <div class="mw-heading mw-heading2"><h2 id="Prognosis">Prognosis</h2></div> <p>Comas can last from several days to, in particularly extreme cases, years. Some patients eventually gradually come out of the coma, some progress to a <a href="/wiki/Persistent_vegetative_state" class="mw-redirect" title="Persistent vegetative state">vegetative state</a> or a <a href="/wiki/Minimally_conscious_state" title="Minimally conscious state">minimally conscious state</a>, and others die. Some patients who have entered a vegetative state go on to regain a degree of awareness; and in some cases may remain in vegetative state for years or even decades such as the <a href="/wiki/Aruna_Shanbaug_case" title="Aruna Shanbaug case">Aruna Shanbaug case</a><sup id="cite_ref-48" class="reference"><a href="#cite_note-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup> or <a href="/wiki/Edwarda_O%27Bara" title="Edwarda O'Bara">Edwarda O'Bara</a>.<sup id="cite_ref-49" class="reference"><a href="#cite_note-49"><span class="cite-bracket">[</span>49<span class="cite-bracket">]</span></a></sup> </p><p>Predicted chances of recovery will differ depending on which techniques were used to measure the patient's severity of neurological damage. Predictions of recovery are based on <a href="/wiki/Statistical" class="mw-redirect" title="Statistical">statistical</a> rates, expressed as the level of chance the person has of recovering. Time is the best general predictor of a chance of recovery. For example, after four months of coma caused by <a href="/wiki/Brain_damage" class="mw-redirect" title="Brain damage">brain damage</a>, the chance of partial recovery is less than 15%, and the chance of full recovery is very low.<sup id="cite_ref-50" class="reference"><a href="#cite_note-50"><span class="cite-bracket">[</span>50<span class="cite-bracket">]</span></a></sup> </p><p>The outcome for coma and vegetative state depends on the cause, location, severity and extent of neurological damage. A deeper coma alone does not necessarily mean a slimmer chance of recovery; similarly, a milder coma does not indicate a higher chance of recovery. The most common cause of death for a person in a vegetative state is secondary <a href="/wiki/Infection" title="Infection">infection</a> such as <a href="/wiki/Pneumonia" title="Pneumonia">pneumonia</a>, which can occur in patients who lie still for extended periods. </p> <div class="mw-heading mw-heading3"><h3 id="Recovery">Recovery</h3></div> <p>People may emerge from a coma with a combination of physical, intellectual, and psychological difficulties that need special attention. It is common for coma patients to awaken in a profound state of confusion and experience <a href="/wiki/Dysarthria" title="Dysarthria">dysarthria</a>, the inability to articulate any speech. Recovery is usually gradual. In the first days, the patient may only awaken for a few minutes, with increased duration of wakefulness as their recovery progresses, and they may eventually recover full awareness. That said, some patients may never progress beyond very basic responses.<sup id="cite_ref-51" class="reference"><a href="#cite_note-51"><span class="cite-bracket">[</span>51<span class="cite-bracket">]</span></a></sup> </p><p>There are reports of people coming out of a coma after long periods of time. After 19 years in a <a href="/wiki/Minimally_conscious_state" title="Minimally conscious state">minimally conscious state</a>, <a href="/wiki/Terry_Wallis" title="Terry Wallis">Terry Wallis</a> spontaneously began speaking and regained awareness of his surroundings.<sup id="cite_ref-52" class="reference"><a href="#cite_note-52"><span class="cite-bracket">[</span>52<span class="cite-bracket">]</span></a></sup> </p><p>A man with brain damage and trapped in a coma-like state for six years was brought back to consciousness in 2003 by doctors who planted electrodes deep inside his brain. The method, called <a href="/wiki/Deep_brain_stimulation" title="Deep brain stimulation">deep brain stimulation</a> (DBS), successfully roused communication, complex movement and eating ability in the man with a traumatic brain injury. His injuries left him in a minimally conscious state, a condition akin to a coma but characterized by occasional, but brief, evidence of environmental and self-awareness that coma patients lack.<sup id="cite_ref-53" class="reference"><a href="#cite_note-53"><span class="cite-bracket">[</span>53<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Society_and_culture">Society and culture</h2></div> <p>Research by Eelco Wijdicks on the depiction of comas in movies was published in Neurology in May 2006. Wijdicks studied 30 films (made between 1970 and 2004) that portrayed actors in prolonged comas, and he concluded that only two films accurately depicted the state of a coma patient and the agony of waiting for a patient to awaken: <i><a href="/wiki/Reversal_of_Fortune" title="Reversal of Fortune">Reversal of Fortune</a></i> (1990) and <i><a href="/wiki/The_Dreamlife_of_Angels" title="The Dreamlife of Angels">The Dreamlife of Angels</a></i> (1998). The remaining 28 were criticized for portraying miraculous awakenings with no lasting side effects, unrealistic depictions of treatments and equipment required, and comatose patients remaining muscular and tanned.<sup id="cite_ref-54" class="reference"><a href="#cite_note-54"><span class="cite-bracket">[</span>54<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Bioethics">Bioethics</h3></div> <p>A person in a coma is said to be in an <a href="/wiki/Unconsciousness" title="Unconsciousness">unconscious</a> state. Perspectives on <a href="/wiki/Personhood" title="Personhood">personhood</a>, <a href="/wiki/Identity_(social_science)" title="Identity (social science)">identity</a> and <a href="/wiki/Consciousness" title="Consciousness">consciousness</a> come into play when discussing the <a href="/wiki/Metaphysics" title="Metaphysics">metaphysical</a> and <a href="/wiki/Bioethics" title="Bioethics">bioethical</a> views on comas. </p><p>It has been argued that unawareness should be just as ethically relevant and important as a state of awareness and that there should be metaphysical support of unawareness as a state.<sup id="cite_ref-:3_55-0" class="reference"><a href="#cite_note-:3-55"><span class="cite-bracket">[</span>55<span class="cite-bracket">]</span></a></sup> </p><p>In the ethical discussions about disorders of consciousness (DOCs), two abilities are usually considered as central: <i>experiencing well-being</i> and <i>having interest</i>. Well-being can broadly be understood as the positive effect related to what makes life good (according to specific standards) for the individual in question.<sup id="cite_ref-:1_56-0" class="reference"><a href="#cite_note-:1-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup> The only condition for well-being broadly considered is the ability to experience its 'positiveness'. That said, because experiencing positiveness is a basic emotional process with <a href="/wiki/Phylogenetics" title="Phylogenetics">phylogenetic</a> roots, it is likely to occur at a completely unaware level and, therefore, introduces the idea of an unconscious well-being.<sup id="cite_ref-:3_55-1" class="reference"><a href="#cite_note-:3-55"><span class="cite-bracket">[</span>55<span class="cite-bracket">]</span></a></sup> As such, the ability of having interests is crucial for describing two abilities which those with comas are deficient in. Having an interest in a certain domain can be understood as having a stake in something that can affect what makes our life good in that domain. An interest is what directly and immediately improves life from a certain point of view or within a particular domain, or greatly increases the likelihood of life improvement enabling the subject to realize some good.<sup id="cite_ref-:1_56-1" class="reference"><a href="#cite_note-:1-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup> That said, sensitivity to reward signals is a fundamental element in the learning process, both consciously and unconsciously.<sup id="cite_ref-57" class="reference"><a href="#cite_note-57"><span class="cite-bracket">[</span>57<span class="cite-bracket">]</span></a></sup> Moreover, the unconscious brain is able to interact with its surroundings in a meaningful way and to produce meaningful information processing of stimuli coming from the external environment, including other people.<sup id="cite_ref-:2_58-0" class="reference"><a href="#cite_note-:2-58"><span class="cite-bracket">[</span>58<span class="cite-bracket">]</span></a></sup> </p><p>According to Hawkins, "1. A life is good if the subject is able to value, or more basically if the subject is able to care. Importantly, Hawkins stresses that caring has no need for cognitive commitment, i.e. for high-level cognitive activities: it requires being able to distinguish something, track it for a while, recognize it over time, and have certain emotional dispositions <i>vis-à-vis</i> something. 2. A life is good if the subject has the capacity for relationship with others, i.e. for meaningfully interacting with other people."<sup id="cite_ref-:1_56-2" class="reference"><a href="#cite_note-:1-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup> This suggests that unawareness may (at least partly) fulfill both conditions identified by Hawkins for life to be good for a subject, thus making the unconscious ethically relevant.<sup id="cite_ref-:2_58-1" class="reference"><a href="#cite_note-:2-58"><span class="cite-bracket">[</span>58<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2></div> <style data-mw-deduplicate="TemplateStyles:r1266661725">.mw-parser-output .portalbox{padding:0;margin:0.5em 0;display:table;box-sizing:border-box;max-width:175px;list-style:none}.mw-parser-output .portalborder{border:1px solid var(--border-color-base,#a2a9b1);padding:0.1em;background:var(--background-color-neutral-subtle,#f8f9fa)}.mw-parser-output .portalbox-entry{display:table-row;font-size:85%;line-height:110%;height:1.9em;font-style:italic;font-weight:bold}.mw-parser-output .portalbox-image{display:table-cell;padding:0.2em;vertical-align:middle;text-align:center}.mw-parser-output .portalbox-link{display:table-cell;padding:0.2em 0.2em 0.2em 0.3em;vertical-align:middle}@media(min-width:720px){.mw-parser-output .portalleft{margin:0.5em 1em 0.5em 0}.mw-parser-output .portalright{clear:right;float:right;margin:0.5em 0 0.5em 1em}}</style><ul role="navigation" aria-label="Portals" class="noprint portalbox portalborder portalright"> <li class="portalbox-entry"><span class="portalbox-image"><span class="noviewer" typeof="mw:File"><span><img alt="icon" src="//upload.wikimedia.org/wikipedia/commons/thumb/d/d6/WHO_Rod.svg/20px-WHO_Rod.svg.png" decoding="async" width="12" height="28" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/d/d6/WHO_Rod.svg/40px-WHO_Rod.svg.png 2x" data-file-width="107" data-file-height="250" /></span></span></span><span class="portalbox-link"><a href="/wiki/Portal:Medicine" title="Portal:Medicine">Medicine portal</a></span></li></ul> <ul><li><a href="/wiki/Brain_death" title="Brain death">Brain death</a>, lack of activity in both cortex, and lack of brainstem function</li> <li><a href="/wiki/Coma_scale" title="Coma scale">Coma scale</a>, a system to assess the severity of coma</li> <li><a href="/wiki/Locked-in_syndrome" title="Locked-in syndrome">Locked-in syndrome</a>, paralysis of most muscles, except ocular muscles of the eyes, while patient is conscious</li> <li><a href="/wiki/Near-death_experience" title="Near-death experience">Near-death experience</a>, type of experience registered by people in a state of coma.</li> <li><a href="/wiki/Persistent_vegetative_state" class="mw-redirect" title="Persistent vegetative state">Persistent vegetative state</a> (vegetative coma), deep coma without detectable awareness. Damage to the cortex, with an intact brainstem.</li> <li><a href="/wiki/Process_Oriented_Coma_Work" class="mw-redirect" title="Process Oriented Coma Work">Process Oriented Coma Work</a>, for an approach to working with residual consciousness in comatose patients.</li> <li><a href="/wiki/Suspended_animation" title="Suspended animation">Suspended animation</a>, the inducement of a temporary cessation or decay of main body functions.</li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-RR-1"><span class="mw-cite-backlink">^ <a href="#cite_ref-RR_1-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-RR_1-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-RR_1-2"><sup><i><b>c</b></i></sup></a></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite id="CITEREFWeyhenmeyerGallman2007" class="citation book cs1">Weyhenmeyer, James A.; Gallman, Eve A. 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Best Interests and Severe Disorders of Consciousness". <i>Finding Consciousness</i>. pp. <span class="nowrap">180–</span>206. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1093%2Facprof%3Aoso%2F9780190280307.003.0011">10.1093/acprof:oso/9780190280307.003.0011</a>. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-0-19-028030-7" title="Special:BookSources/978-0-19-028030-7"><bdi>978-0-19-028030-7</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=bookitem&rft.atitle=What+is+Good+for+Them%3F+Best+Interests+and+Severe+Disorders+of+Consciousness&rft.btitle=Finding+Consciousness&rft.pages=%3Cspan+class%3D%22nowrap%22%3E180-%3C%2Fspan%3E206&rft.date=2016&rft_id=info%3Adoi%2F10.1093%2Facprof%3Aoso%2F9780190280307.003.0011&rft.isbn=978-0-19-028030-7&rft.aulast=Hawkins&rft.aufirst=Jennifer&rfr_id=info%3Asid%2Fen.wikipedia.org%3AComa" class="Z3988"></span></span> </li> <li id="cite_note-57"><span class="mw-cite-backlink"><b><a href="#cite_ref-57">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite class="citation journal cs1">"Henry Adams: The Middle Years. By Ernest Samuels. (Cambridge, Mass.: Belknap Press of Harvard University Press. 1958. Pp. xiv, 514. $7.50.) and Henry Adams: The Major Phase. By Ernest Samuels. (Cambridge, Mass.: Belknap Press of Harvard University Press. 1964. Pp. xv, 687. $10.00.)". <i>The American Historical Review</i>. January 1966. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1086%2Fahr%2F71.2.709">10.1086/ahr/71.2.709</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+American+Historical+Review&rft.atitle=Henry+Adams%3A+The+Middle+Years.+By+Ernest+Samuels.+%28Cambridge%2C+Mass.%3A+Belknap+Press+of+Harvard+University+Press.+1958.+Pp.+xiv%2C+514.+%247.50.%29+and+Henry+Adams%3A+The+Major+Phase.+By+Ernest+Samuels.+%28Cambridge%2C+Mass.%3A+Belknap+Press+of+Harvard+University+Press.+1964.+Pp.+xv%2C+687.+%2410.00.%29&rft.date=1966-01&rft_id=info%3Adoi%2F10.1086%2Fahr%2F71.2.709&rfr_id=info%3Asid%2Fen.wikipedia.org%3AComa" class="Z3988"></span></span> </li> <li id="cite_note-:2-58"><span class="mw-cite-backlink">^ <a href="#cite_ref-:2_58-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-:2_58-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite id="CITEREFFariscoEvers2016" class="citation book cs1">Farisco, Michele; Evers, Kathinka, eds. (2016). <i>Neurotechnology and Direct Brain Communication</i>. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.4324%2F9781315723983">10.4324/9781315723983</a>. <a href="/wiki/ISBN_(identifier)" class="mw-redirect" title="ISBN (identifier)">ISBN</a> <a href="/wiki/Special:BookSources/978-1-317-52959-0" title="Special:BookSources/978-1-317-52959-0"><bdi>978-1-317-52959-0</bdi></a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=book&rft.btitle=Neurotechnology+and+Direct+Brain+Communication&rft.date=2016&rft_id=info%3Adoi%2F10.4324%2F9781315723983&rft.isbn=978-1-317-52959-0&rfr_id=info%3Asid%2Fen.wikipedia.org%3AComa" class="Z3988"></span><sup class="noprint Inline-Template" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citing_sources" title="Wikipedia:Citing sources"><span title="This citation requires a reference to the specific page or range of pages in which the material appears. (December 2024)">page needed</span></a></i>]</sup></span> </li> </ol></div></div> <div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2></div> <ul><li><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222" /><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.merriam-webster.com/dictionary/Coma">"Coma"</a>. <i><a href="/wiki/Merriam-Webster" title="Merriam-Webster">Merriam-Webster.com Dictionary</a></i>. Merriam-Webster.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=unknown&rft.jtitle=Merriam-Webster.com+Dictionary&rft.atitle=Coma&rft_id=https%3A%2F%2Fwww.merriam-webster.com%2Fdictionary%2FComa&rfr_id=info%3Asid%2Fen.wikipedia.org%3AComa" class="Z3988"></span></li></ul> <style data-mw-deduplicate="TemplateStyles:r1235681985">.mw-parser-output .side-box{margin:4px 0;box-sizing:border-box;border:1px solid #aaa;font-size:88%;line-height:1.25em;background-color:var(--background-color-interactive-subtle,#f8f9fa);display:flow-root}.mw-parser-output .side-box-abovebelow,.mw-parser-output .side-box-text{padding:0.25em 0.9em}.mw-parser-output .side-box-image{padding:2px 0 2px 0.9em;text-align:center}.mw-parser-output .side-box-imageright{padding:2px 0.9em 2px 0;text-align:center}@media(min-width:500px){.mw-parser-output .side-box-flex{display:flex;align-items:center}.mw-parser-output .side-box-text{flex:1;min-width:0}}@media(min-width:720px){.mw-parser-output .side-box{width:238px}.mw-parser-output .side-box-right{clear:right;float:right;margin-left:1em}.mw-parser-output .side-box-left{margin-right:1em}}</style><style data-mw-deduplicate="TemplateStyles:r1237033735">@media print{body.ns-0 .mw-parser-output .sistersitebox{display:none!important}}@media screen{html.skin-theme-clientpref-night .mw-parser-output .sistersitebox img[src*="Wiktionary-logo-en-v2.svg"]{background-color:white}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .sistersitebox img[src*="Wiktionary-logo-en-v2.svg"]{background-color:white}}</style><div class="side-box side-box-right plainlinks sistersitebox"><style data-mw-deduplicate="TemplateStyles:r1126788409">.mw-parser-output .plainlist ol,.mw-parser-output .plainlist ul{line-height:inherit;list-style:none;margin:0;padding:0}.mw-parser-output .plainlist ol li,.mw-parser-output .plainlist ul li{margin-bottom:0}</style> <div class="side-box-flex"> <div class="side-box-image"><span class="noviewer" typeof="mw:File"><a href="/wiki/File:Wiktionary-logo-en-v2.svg" class="mw-file-description"><img alt="" src="//upload.wikimedia.org/wikipedia/commons/thumb/9/99/Wiktionary-logo-en-v2.svg/40px-Wiktionary-logo-en-v2.svg.png" decoding="async" width="40" height="40" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/9/99/Wiktionary-logo-en-v2.svg/60px-Wiktionary-logo-en-v2.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/9/99/Wiktionary-logo-en-v2.svg/80px-Wiktionary-logo-en-v2.svg.png 2x" data-file-width="512" data-file-height="512" /></a></span></div> <div class="side-box-text plainlist">Look up <i><b><a href="https://en.wiktionary.org/wiki/coma" class="extiw" title="wiktionary:coma">coma</a></b></i> in Wiktionary, the free dictionary.</div></div> </div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1235681985" /><div class="side-box metadata side-box-right"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1126788409" /> <div class="side-box-flex"> <div class="side-box-image"><span class="noviewer" typeof="mw:File"><span><img alt="" src="//upload.wikimedia.org/wikipedia/commons/thumb/3/32/Scholia_logo.svg/40px-Scholia_logo.svg.png" decoding="async" width="40" height="39" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/3/32/Scholia_logo.svg/60px-Scholia_logo.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/3/32/Scholia_logo.svg/80px-Scholia_logo.svg.png 2x" data-file-width="107" data-file-height="104" /></span></span></div> <div class="side-box-text plainlist"><a href="https://www.wikidata.org/wiki/Wikidata:Scholia" class="extiw" title="d:Wikidata:Scholia">Scholia</a> has a profile for <a href="https://iw.toolforge.org/scholia/Q159557" class="extiw" title="toolforge:scholia/Q159557"><b>coma <small>(Q159557)</small></b></a>.</div></div> 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style="width:1%;background: #EAECF0;color:black;">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><div style="position:relative; float:right; font-size:0.8em;"><a href="https://www.wikidata.org/wiki/Q159557" class="extiw" title="d:Q159557">D</a></div><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-11" title="ICD-11">11</a></b>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse/latest-release/mms/en#1328725971">MB20.1</a></li><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10" title="ICD-10">10</a></b>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/R40.2">R40.2</a></li><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9-CM</a></b>: <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=780.01">780.01</a></li><li><b><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a></b>: <a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D003128">D003128</a></li><li><b><a href="/wiki/Diseases_Database" title="Diseases Database">DiseasesDB</a></b>: <a rel="nofollow" class="external text" href="http://www.diseasesdatabase.com/ddb16940.htm">16940</a></li></ul></div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">External resources</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/Patient_UK" title="Patient UK">Patient UK</a></b>: <a rel="nofollow" class="external text" href="https://patient.info/doctor/coma">Coma</a></li></ul></div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374" /><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235" /></div><div role="navigation" class="navbox" aria-labelledby="Disorders_of_consciousness146" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374" /><style data-mw-deduplicate="TemplateStyles:r1239400231">.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output .navbar-collapse{float:left;text-align:left}.mw-parser-output .navbar-boxtext{word-spacing:0}.mw-parser-output .navbar ul{display:inline-block;white-space:nowrap;line-height:inherit}.mw-parser-output .navbar-brackets::before{margin-right:-0.125em;content:"[ "}.mw-parser-output .navbar-brackets::after{margin-left:-0.125em;content:" ]"}.mw-parser-output .navbar li{word-spacing:-0.125em}.mw-parser-output .navbar a>span,.mw-parser-output .navbar a>abbr{text-decoration:inherit}.mw-parser-output .navbar-mini abbr{font-variant:small-caps;border-bottom:none;text-decoration:none;cursor:inherit}.mw-parser-output .navbar-ct-full{font-size:114%;margin:0 7em}.mw-parser-output .navbar-ct-mini{font-size:114%;margin:0 4em}html.skin-theme-clientpref-night .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}@media(prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}}@media print{.mw-parser-output .navbar{display:none!important}}</style><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Disorders_of_consciousness" title="Template:Disorders of consciousness"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Disorders_of_consciousness" title="Template talk:Disorders of consciousness"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Disorders_of_consciousness" title="Special:EditPage/Template:Disorders of consciousness"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Disorders_of_consciousness146" style="font-size:114%;margin:0 4em"><a href="/wiki/Disorders_of_consciousness" class="mw-redirect" title="Disorders of consciousness">Disorders of consciousness</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Unconsciousness" title="Unconsciousness">Unconsciousness</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Minimally_conscious_state" title="Minimally conscious state">Minimally conscious state</a></li> <li><a href="/wiki/Persistent_vegetative_state" class="mw-redirect" title="Persistent vegetative state">Persistent vegetative state</a></li> <li><a href="/wiki/Obtundation" title="Obtundation">Obtundation</a></li> <li><a class="mw-selflink selflink">Coma</a></li> <li><a href="/wiki/Brainstem_death" title="Brainstem death">Brainstem death</a></li> <li><a href="/wiki/Stupor" title="Stupor">Stupor</a> <ul><li><a href="/wiki/Sopor_(sleep)" title="Sopor (sleep)">Sopor</a></li> <li><a href="/wiki/Sleep" title="Sleep">Sleep</a></li> <li><a href="/wiki/Somnolence" title="Somnolence">Somnolence</a></li></ul></li> <li><a href="/wiki/Cataplexy" title="Cataplexy">Cataplexy</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Syncope_(medicine)" title="Syncope (medicine)">Syncope</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Heat_syncope" title="Heat syncope">Heat syncope</a></li> <li><a href="/wiki/Vasovagal_episode" class="mw-redirect" title="Vasovagal episode">Vasovagal episode</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Altered_level_of_consciousness" title="Altered level of consciousness">Alteration of<br />consciousness</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Locked-in_syndrome" title="Locked-in syndrome">Locked-in syndrome</a></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374" /><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235" /><style data-mw-deduplicate="TemplateStyles:r1038841319">.mw-parser-output .tooltip-dotted{border-bottom:1px dotted;cursor:help}</style><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1038841319" /><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1038841319" /><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1038841319" /></div><div role="navigation" class="navbox authority-control" aria-label="Navbox1488" style="padding:3px"><table 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