Coma after a stroke occurs as a result of brain damage. It is accompanied by a complete shutdown of all human systems. This condition occurs as a protection of the body from further destruction and is reversible, but only under certain conditions. Coma after a stroke resolves only if the patient is given appropriate care and treatment.
Causes of coma
Coma after a stroke occurs for several reasons:
- Profuse bleeding in the cranial cavity, namely directly into the human brain. This reason is the most common.
- Ischemic cerebrovascular disease. Pathology is accompanied by a complete cessation of blood flow to the vessels of the brain. This, in turn, causes acute oxygen starvation and, accordingly, a coma.
- Coma can leaddegenerative state of the walls of blood vessels. The pathology is called atheroma.
- In case of severe intoxication of the body due to exposure to toxic chemicals and / or other dangerous substances, coma occurs as a result of an overdose.
- With a sudden change in the state of the connective tissue within the brain. This pathology is called callaginesis.
- When a specific protein accumulates in the vessels of the brain.
- Coma can be the result of a lack of certain vitamins in the body. This condition is extremely rare, but still occurs in medical practice.
- Blood disease. This may be due to an infection or an autoimmune disease.
Types of strokes
The main cause of coma is a stroke. There are several types of this pathology.
- Stroke resulting from atherosclerosis. It occurs due to the formation of a plaque on the vessel wall, which, in turn, is formed from an excess of cholesterol in the body. A thrombus that can block blood flow can form in another part of the vessel and be transferred to the vessels of the brain with blood flow.
- A clot that can cut off blood flow can form in one of the ventricles of the heart, and then be transferred to the narrow vessels of the brain, where it gets stuck. This phenomenon is called cardioembolism.
- Lacunar stroke is a pathology caused by vessel deformity. This leads to diabetes mellitus or another disease that can destroy the walls of blood vessels.
- A hemodynamic disorder that causes a stroke is most often accompanied by chronic hypertension - high blood pressure.
Danger of pathology
If a stroke was accompanied by profuse hemorrhage from a damaged vessel, then coma in this case is almost inevitable. If the patient is not provided with competent medical care in time, then he will have not only a coma after a stroke, but also paralysis of the limbs or half of the body. Speech, vision, hearing, and a number of other functions may also be lost.
What is a coma
Coma after a stroke is a common condition, but in each individual case it proceeds according to an individual scenario. The patient loses contact with the outside world and the sensitivity of various organs, the time spent in this state depends on the severity and extent of the stroke.
According to various sources, this condition in a patient can last from 2-3 days to several years. And this is provided that the person received medical assistance on time. The prognosis for those patients who received it too late, as a rule, is disappointing.
Signs of a coma
Coma does not always come on suddenly, accompanied by a sudden loss of consciousness. Sometimes a person's brain fades gradually, while the patient's behavior shows characteristic signs.
- The patient's speech is disturbed, words are given with difficulty, the voice sounds weak - barely audible. An attempt to pronounce a phrase is given to a person with difficulty.
- The patient's mind is confused, delirium begins.
- The patient loses the ability to move independently. He needs help to stand upright.
- Painful drowsiness occurs, and sleep itself can last from 10 to 20 hours.
- Often the patient begins to feel sick, up to severe vomiting.
- Pulse becomes weak, hard to feel.
- The frequency of inhalation-exhalation is reduced to a dangerous minimum.
- The person's hands and feet become cold.
- The patient's anal sphincter and bladder relax. This is accompanied by involuntary bowel movements and urination.
- Pupils stop responding to light - they dilate and stay in that position.
When to sound the alarm?
After a stroke, entering a coma, the patient can reflexively move his limbs, breathe, swallow food. If there is no such activity, then it is connected to artificial respiration and force-feeding equipment.
If a person has one or more signs of an impending coma, they should be seen by a doctor immediately. After all, it happens that the patient himself does not suspect that he had a stroke, and writes off the symptoms that have arisen as a severe headache or a sharp rise in blood pressure.
Types of coma
It is possible to fall into a coma after a stroke with any severity of the stroke, because the coma is also divided into different degrees of depth.
- Mild, or first, degree of coma is manifested by the absence of the patient's reaction to stimuli, but by the presence of the ability to independentlybreathe and eat. He can even move within the bed, that is, change his position. Sometimes he reacts to a direct appeal to him. The chances of surviving with a coma of the 1st tbsp. after a stroke are very high.
- In a coma of the second degree, the patient is in deep sleep. His breathing is unstable, ventricular fibrillation and rare convulsive muscle contractions are observed. The survival rate for this degree of coma is extremely low.
- In the third stage of coma, all functions of the organisms are inhibited - weak breathing, interruptions in the heartbeat, lack of response to light and stimuli. The patient does not control his bladder and anal sphincter. Mortality with this degree of coma is almost one hundred percent.
- In the fourth stage of the coma, the patient is unable to breathe on his own, his body temperature is dangerously low, there is muscle atony, lack of response to light and stimuli. The human brain does not perform any functions. Mortality is 100%.
The prognosis of coma after a stroke depends entirely on the degree of pathology, so it is extremely important to correctly diagnose the severity of the damage.
Diagnosis of coma
When calculating the chances of surviving a coma after a stroke, doctors rely on more than just signs and symptoms that appear outwardly. For this, a laboratory blood test and instrumental studies of the brain are also used. This may be an X-ray, angiogram or a CT scan. The last method is the most efficient and informative. Only a complete study and analysis of the damage caused to the brain by a stroke,as well as identifying the cause of a stroke can predict the patient's condition.
Therapy of a comatose patient
When a person has fallen into a coma after a stroke, all therapy is aimed at improving and stabilizing his vital functions. Respiratory rate, heartbeat, nutrition are necessarily restored. If the patient cannot breathe on his own, he is connected to a ventilator. Nutrition is provided intravenously. The heart monitor constantly monitors the work of the heart, and if there is a failure of the heartbeat, the patient is immediately helped to stimulate the heart muscle.
In addition, a number of activities are carried out on the human brain, including a surgical operation to eliminate the consequences of a stroke, namely blood and damaged blood vessels. The blood flow in the brain is restored so that the blood continues to supply oxygen to the brain cells.
A person in a coma after a stroke must undergo a full course of treatment for the consequences, only this increases the chances of survival.
Caring for the comatose patient
A coma after a stroke can last for an arbitrarily long time - from 3 days to several years, and the patient's survival depends not only on therapy, but also on proper care.
For example, if a patient was in a coma for a month after a stroke or even longer, and at the same time received adequate treatment and care, then he has a significant chance of recovering even after such a long period of being unconscious.
Yes, food is providednot only through the introduction of nutrient solutions into the blood, but also through special tubes in the stomach. They serve liquid food, similar in consistency and composition to baby food.
The patient must be kept clean and regularly turned over by medical personnel from side to side to prevent the development of bedsores. His skin should be treated with special antibacterial solutions and massaged at the points of contact with the mattress to improve blood circulation.
At the same time, the patient is regularly washed, including the hair on the head and body. The oral cavity is treated with special solutions so that caries does not develop.
Rehabilitation after a coma
After a coma and a stroke, the patient needs proper rehabilitation. Indeed, during the unconscious state, the muscles atrophy, the general condition of the body worsens.
The patient does not always come to his senses completely and immediately. As a rule, this also takes time. First, a person starts delirium with short enlightenment of consciousness. Then these periods begin to lengthen. The reaction to external stimuli and pain returns.
For a full recovery, the patient is treated by a physiotherapist, restoring muscle tone with the help of apparatus therapy, and most importantly, physical education. The patient begins to do exercises gradually, from a prone position, increasing the load over time. All exercises are done under the supervision of a physiotherapist and according to his recommendations.
An important aspect of rehabilitation is assistanceclose relatives of the patient. Under all these conditions, a person after a stroke and coma can restore all his functions completely. Even if a stroke led to irreversible changes in the human brain. After all, it is known that the functions of damaged areas of the brain can be taken over by its he althy parts. There are cases when the patient continued to live a normal life after the removal of an entire hemisphere of the brain. Of course, after a long course of treatment and rehabilitation.
Prevention
To prevent coma, you need to avoid the risk of stroke in every possible way. To do this, you need to monitor your he alth, regularly undergo medical examinations. You need to give up bad habits such as smoking and drinking alcohol. After all, they destroy the walls of blood vessels in the brain. You need to eat right, avoid eating fatty and fried foods, as this increases the risk of developing cholesterol plaques on the walls of blood vessels.
To improve blood flow, and therefore normalize blood pressure, you need to exercise regularly or at least walk more. This is especially important for people who lead a sedentary lifestyle associated with their professional activities.
It is very important to know the first symptoms of a stroke - numbness of the skin of the face, paralysis of the limbs, loss of consciousness, tachycardia. After all, the sooner a person is helped with a stroke, the higher his chances of a full recovery. A coma that accompanies a stroke is a very dangerous condition bordering on death. In this case, prompt action and proper follow-up therapy are important. After a stroke and coma, there are chances for a full recovery of all body functions, but the rehabilitation period will take a long time anyway.
