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 defense of the body from further destruction and is reversible, but only under certain conditions. A coma after a stroke passes only if the patient has been set up to care for the situation and the correct treatment is provided.
Causes of Coma
Coma after a stroke occurs for several reasons:
- Heavy 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 into the vessels of the brain. This, in turn, causes acute oxygen starvation and, accordingly, coma.
- A coma can lead to a degenerative state of the walls of the vessels. Pathology is called atheroma.
- With 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 connective tissue within the brain. This pathology is called callaginosis.
- With the accumulation of a specific protein in the vessels of the brain.
- Coma may result from a lack of certain vitamins in the body. This condition occurs extremely rarely, 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 stroke. There are several types of this pathology.
- A stroke resulting from atherosclerosis. It occurs due to the formation of plaque on the vessel wall, which, in turn, is formed from an excess of cholesterol in the body. A blood clot that can block blood flow can be formed in another part of the vessel and transported to the blood vessels of the brain.
- A blood clot that can block blood flow can form in one of the ventricles of the heart, and then travel to the narrow vessels of the brain, where it gets stuck. This phenomenon is called cardioembolism.
- Lacunar stroke is a pathology caused by deformation of the vessel. This leads to diabetes mellitus or another disease that can destroy the walls of blood vessels.
- A hemodynamic disorder causing 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 a coma in this case is almost inevitable. If the patient is not provided with competent medical care on 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 disappear.
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 touch 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, such a condition in a patient can last from 2-3 days to several years. And this is provided that the person was provided with medical care on time. The prognosis of those patients to whom it was given too late is usually disappointing.
Signs of coma
A coma does not always occur suddenly, accompanied by a sharp loss of consciousness. Sometimes the human brain dies away gradually, while characteristic features are traced in the patient's behavior.
- The patient’s speech is disturbed, words are given with difficulty, the voice is weak - barely audible. An attempt to pronounce a phrase is given to a person with difficulty.
- The patient's consciousness is confused, delirium begins.
- The patient loses the ability to move independently. In order to stand upright, he needs outside help.
- Painful drowsiness occurs, and the sleep itself can last from 10 to 20 hours.
- Often the patient begins to feel sick, up to severe vomiting.
- The pulse becomes weak, it is felt with difficulty.
- The frequency of inspirations-expirations is reduced to a dangerous minimum.
- Hands and feet become cold.
- The anal sphincter and the patient's bladder relax. This is accompanied by involuntary bowel movements and urination.
- The pupils stop responding to light - they expand and remain in this 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 forced feeding equipment.
If a person has one or more signs of an approaching coma, it must be immediately shown to a doctor. After all, it happens that the patient himself does not suspect that he had a stroke, and attributes the symptoms to a severe headache or a sharp increase in blood pressure.
Types of coma
You can fall into a coma after a stroke with any severity of a stroke, because a coma is also divided into various degrees of depth.
- Mild, or first, degree of coma is manifested by the absence of the patient's response to stimuli, but by the ability to breathe and eat on their own. He can even move within the bed, that is, change his position. Sometimes reacts to a direct appeal to him. Chances to survive with a coma of the 1st art. after a stroke are very high.
- With 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. Survival at this degree of coma is extremely low.
- In the third stage of coma, all functions of the body are inhibited - weak breathing, interruptions in the heartbeat, lack of reaction to light and irritants. The patient does not control his bladder and anal sphincter. Mortality with such a degree of coma is almost one hundred percent.
- In the fourth stage of coma, the patient is not able to breathe on his own, his body temperature is dangerously low, muscle atony, lack of reaction to light and irritants are observed. The human brain does not perform any functions. Mortality is one hundred percent.
The prognosis of coma after a stroke completely depends on the degree of pathology, therefore it is extremely important to correctly diagnose the severity of damage.
Diagnosis of coma
Counting the chances of surviving a coma after a stroke, doctors rely not only on signs and symptoms that appear externally. For this, a laboratory blood test and instrumental studies of the brain are also used. This may be an x-ray, angiogram or computed tomography. The latter method is the most effective and informative. Only a complete study and analysis of the damage caused to the brain by a stroke, as well as identifying the causes of the stroke, make it possible to predict the condition of the patient.
Comatose Therapy
When a person falls into a coma after a stroke, all therapy is aimed at improving and stabilizing his vital functions. Be sure to restore breathing rate, heartbeat, nutrition. If the patient cannot breathe on his own, he is connected to a ventilator. Nutrition is administered intravenously. The cardiomonitor constantly monitors the work of the heart, and if a heart failure occurs, the patient is immediately helped to stimulate the heart muscle.
In addition, a number of measures are carried out on the human brain, including a surgical operation to eliminate the consequences of a stroke, namely blood and damaged 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 should undergo a full course of treatment of the consequences, only this increases the chances of survival.
Comatose Care
A coma can last after a stroke arbitrarily long - from 3 days to several years, and the patient's survival in this case depends not only on therapy, but also on proper care for it.
For example, if a patient has been in a coma for a month after a stroke and even longer and at the same time has received treatment and care adequate to his condition, then he has significant chances to recover, even after such a long period of unconsciousness.
So, nutrition is carried out not only through the introduction of nutrient solutions into the blood, but also through special tubes in the stomach. They serve liquid food similar in texture and composition to baby food.
The patient must be kept clean and regularly turned by medical personnel from side to side to exclude the development of pressure sores. His skin should be treated with special antibacterial solutions and massaged in places of contact with the mattress to improve blood circulation.
In this case, the patient is regularly washed, including 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 an unconscious state, the muscles atrophy, the general condition of the body worsens.
Not always the patient comes to his senses completely and immediately. As a rule, this also takes time. First, a person begins nonsense with short enlightenments of consciousness. Then these periods begin to lengthen. The reaction to external stimuli and pain returns.
For a complete recovery, the patient is treated by a physiotherapist, restoring muscle tone with the help of hardware therapy, and most importantly - physical education. The patient begins to do the 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 in rehabilitation is the help of close relatives of the patient. Under all these conditions, a person after a stroke and coma can restore all his functions completely. Even if the stroke has led to irreversible changes in the human brain. After all, it is known that the functions of damaged parts of the brain can be taken over by its healthy parts. There are cases when the patient continued to live a normal life after removing the entire hemisphere of the brain. Of course, after a long course of treatment and rehabilitation.
Prevention
For the prevention of coma, the risk of a stroke should be avoided in every possible way. To do this, you need to monitor your health, regularly undergo medical examinations. You need to give up bad habits, such as smoking and drinking alcohol. After all, they destroy the walls of the vessels of the brain. You need to eat properly, without 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 hence normalize blood pressure, you must regularly exercise or at least walk more. This is especially important for people leading a sedentary lifestyle associated with their professional activities.
It is very important to know the first symptoms of a stroke - numbness of the face, paralysis of the limbs, loss of consciousness, tachycardia. After all, the sooner a person will be helped with a stroke, the higher his chances of a full recovery. The coma accompanying a stroke is a very dangerous condition bordering on death. In this case, prompt action and proper subsequent therapy are important. After a stroke and coma, there are chances for a full restoration of all body functions, but the rehabilitation period in any case will take a lot of time.