Coma & The Vegetative State
Pat, help me understand my friend who was involved in an auto accident, has several broken bones, a tracheotomy (done at the scene), has been hospitalized for 7 days, has swelling of the brain which has been drained. Doctors are not saying or doing much until the swelling goes down. I guess he is on a breathing apparatus; he is not awake; he is in a coma. Do swelling and blood clots in the brain mean severe brain damage? Can a brain scan be performed on a swollen brain?
The first days following a serious brain injury are difficult for all involved: family and friends struggle with shock, hope, fear of the unknown, and doctors also struggle with the impossibility of predicting outcome. Tests can be performed on the damaged brain to assess its condition (e.g., CT scan, MRI); however, a sound diagnosis is too much to ask for in the early stage of trauma. Your friend’s injury sounds severe as you describe it. Technically, an injury that results in a coma or a period of unconsciousness that lasts more than 24 hours can be classified as severe (versus mild). For more information on severe brain injury, coma, and outcome, please take a look at the FAQ’s on this Internet site and consult your state Brain Injury Association. Several complex factors will determine your friend’s outcome. What you can do is be there for him; your presence and support will help more than you may think.
At the age of 18, I sustained a severe head injury when I was hit by a driver in a pick-up truck, and I was as messed up as a Don King hair-do. I was in a coma for 8 weeks, and I really don't remember much of my recovery except that the food sucked. I guess I'm either too stupid to realize the severity of my injury or too stubborn to let it keep me down, because I'm in college now trying to get into the field of cognitive rehabilitation. I'd like any information you can provide on this topic. By the way, the best advice I can give others: NEVER GIVE UP!
The Don-King-hairdo syndrome is one of the most disturbing results of a head injury. It's ugly, it's humiliating, it ruins lives...don't even kid about it. Thank heaven you were granted entrance into a college in spite of it. Some good sources of information on cognitive rehabilitation include university libraries (look at the scientific journals), medical college libraries, and university- and hospital-based federal research centers such as the Model Systems of Care and Research & Training Centers. For specific information on resources near you, contact your state Brain Injury Association or the national Brain Injury Association at 1-800-444-6443 . A wealth of information exists.
My father had heart failure and it took him 20 minutes to bring him back. The doctor gave him medication and he was supposed to wake up in about 10 hours. It has been over 72 hours and his is in a coma. His heart and organs are functioning well and a brain scan showed no signs of stroke. Can you tell me how long it takes to get out of a coma?
Afraid I can’t answer that one. These things vary from patient to patient and are always hard to predict. The physician treating your father is the best source of information about his particular case. It sounds like your father may have experienced what is called a hypoxic coma. This means that there is oxygen deprivation to the brain. A heart attack is one of the most common causes of hypoxic coma. Because the brain does not store oxygen, the brain needs a constant supply. If that supply is interrupted, brain cells begin to die.
Generally, the longer in a coma the less likely there will be a good outcome. However, if your father shows good brain function, there is a good chance he will "emerge" from his coma. Sensory stimulation may help him emerge from the coma, although there is some controversy over the effectiveness of this intervention. After he is awake, he may need a significant amount of rehabilitation therapy and may experience many of the problems with attention, memory and behavior that are experienced by other survivors of brain injury.
My son has a severe brain injury (he fell 35 ft). He postured a lot in the hospital and now he is in a rehab hospital. They had him on Haldol and also had him on Botox. It stopped the posturing, but now he is no longer on the Haldol and he is starting to posture again. Why would he posture? I am trying to get the Doctors to do something quick before it gets so they can't control it. My son is in a coma yet, he has been in one for 2 1/2 months and they think he is improving, but not while he is posturing. Also he fixes his eyes to the right at a certain time of the day some days. He tracks well and responds to sound. Can you give me any encouragement?
Abnormal posturing is usually a sign of serious Central Nervous System damage. Certainly, a 35-foot fall will cause serious damage. Normally when a muscle contracts, the muscles on the other side of the joint provide resistance to contraction. Abnormal posturing occurs when damage to the CNS prevents the muscles on the other side from acting in opposition. In the case of a prolonged coma, posturing can continue for a long period of time. Obviously, I can’t say anything specific about your son’s case – you should consult with his physician for a prognosis. In general, most people eventually "emerge" from comas. However, it is also true that your son sustained a very severe injury and has been in a coma for an extended period of time. You need to remain optimistic. You also need to be realistic – even if your son emerges from the coma, there will likely be a long rehabilitation process and many long-term changes.
Be sure to talk with your son’s physicians and try to understand the nature and extent of his injuries and get a realistic prognosis. Keep in mind, you also need to take care of yourself and your family. Consider talking to a counselor or clergy. We all need help to get through the bad times.
My brother fell 20 feet and hit his head while at work. This fall has left him in a coma for 55 days now, and all the doctors have been telling us is to wait and hope. My family and I understand that, But Alan started responding to small commands such as - Give a thumbs up, point one finger, or squeeze my hand if your name is Alan. He has even mouthed "Hi," and told them that he was 28. A week later he started having seizures and is back in the TICU. We talked to the doctors and they say that Alan has fluid on the brain again and that the fluids are not draining. They said they would put a shunt in to help the fluids drain, but they said if they put the shunt in Alan still only has a one percent chance of him being Alan again. Now they are telling us that all the little steps that Alan is making are not purposeful. I am totally confused. I don't understand how one minute they are purposeful and now they are not. I will never give up on the power of God, and the strong will that my brother has. Pat if there is any advice that you could give me and my family I would deeply appreciate it. Missing Alan!!!
20 feet is a very long way to fall and survive. As I always tell families who have a loved one in a prolonged coma, the treating physician is the best source of information about the prognosis. He or she best understands the extent of your brother’s injuries and his response to treatment. Be sure to talk with your brother’s physicians and try to understand the nature and extent of his injuries and get a realistic prognosis.
In general, most people eventually "emerge" from comas. However, it is also true that your brother sustained a very severe injury and has been in a coma for an extended period of time. You need to remain optimistic. You also need to be realistic – even if your brother emerges from the coma, there will likely be a long rehabilitation process and many long-term changes. When they say there is only a 1% chance that he will be "…Alan again" they are probably trying to prepare you for long-term consequences. If Alan does emerge from his coma, he is not going to be the brother you had before. Most people who emerge from a prolonged coma after a severe brain injury have significant difficulties related to memory, attention and concentration, motor skills, communication skills, or personality changes. Even if Alan’s improvement is better than anyone expects, he will struggle with some significant changes from this injury.
As for the "purposeful" behavior, this is one of the signs that people look for to assess the level of coma. You are describing purposeful behavior because you saw Alan follow some commands. However, it can be difficult to distinguish between a patient just responding to stimuli and someone actually responding to a command. Even harder to assess are situations where the person is sometimes able to follow commands, but can’t at other times. In Alan’s case, it may also be that he experienced a setback when he had the "fluid" on his brain, and he may need more time to get back to where he can follow commands.
Keep in mind, you also need to take care of yourself and your family. Religious faith often helps through bad times. Consider discussions with clergy, a psychologist or counselor to talk about your feelings and the effect this tragic event has had on your family.
I was talking to someone and they told a story of coma that I find hard to believe. This person said that they were hit on the head with a large book from a height of about 10-12 feet. She claims she was in a coma for three weeks. She also claims that she woke up with no disabilities and no need for rehabilitation. She claims to have been back to work within a week of waking up. I do not believe that this is possible. From what I understand, it takes quite a bit of trauma to keep a person in a coma for that long. And sustaining that kind of trauma means that part of the brain were damaged severely. That a coma of as little as a week would cause someone to have months of therapy. That they would have to re-learn a lot of menial tasks including walking, taking care of themselves and basic cognitive functions. Am I wrong in my assumption that all head injuries that lead to a prolonged coma require extensive rehabilitation or can someone just wake up and have no after-affects of a traumatic brain injury?
At the very least it’s an extremely unusual story. Certainly the usual course of recovery from coma is slow and requires substantial rehabilitation. Some people are able to recover many of their pre-injury skills, but this also takes considerable time and usually many hours of rehabilitation. Without having valid medical records, Pat is skeptical of this woman’s report. On the other hand, strange things do occasionally happen.
Our 39 yr. old brother suffered a closed head injury Sep. 11, 1999. He sustained shearing to midbrain, thalamus, and brainstem. He was in a coma for several days following injury and is now what is considered a "locked in" state. As of yet, his left side seems to be unaffected, while he has hemiplegia to right. He has made more progress than the doctor's ever thought he would. For instance, he'll answer yes/no questions using his fingers, and is learning American Sign Language alphabet. His memory doesn't seem to be impaired; he knows his name, age, brother's names, etc. He has also started writing his name on a notepad. Recently, he has started exhibiting somewhat aggressive behavior-pulling our hair, noses, and such. Our question to you is-is this new behavior common with such injuries? Some of the nurses at the Rehab hospital have told us this means he is "waking up", it that true? And, is it possible to recover from an injury to the brainstem?
Yes, agitation or unusual behaviors are often seen as patients begin to emerge from a coma. "Locked in" states generally refer to patients who are seen as "awake" but cannot consistently respond to or act on the environment. As for future recovery, it is likely that he will show continued improvements. However, you should probably be prepared for the fact that your brother’s recovery will probably be slow and he may never "fully" recover. Many patients wither severe injuries eventually can resume many normal functions, but some will require long-term care. As Pat always says – it is important to be very optimistic – but also realistic. Please be sure to talk to your brother’s doctors for information about his specific prognosis.
I have a nephew that has been in a pre-vegetative state for 1 year and 6 months. He is still in the hospital. He hung himself. He also suffers from schizophrenia. The doctors have given up hope of recovery. He can tell when someone is in the room, and likes for you to read to him. Do you know of any other cases like this where they recover?
Most recovery takes place in the first 6-12 months after an injury. Lack of oxygen to the brain can quickly kill brain cells, and it sounds like your brother probably suffered some serious damage. You can hope for continued improvements as these can continue to occur even years after an injury. However hoping for a "full recovery" may be too optimistic (but consult with your nephew’s physicians for specific information about him). I hope you will continue to give your nephew love and support and visit him as often as you can.
My brother died from anoxia due to an accident last year after living in a vegetative state for 3 months. Although at first in an ER, he was later transferred to a long-term care facility. I was shocked to see how many young people were there. My questions arise out of sheer curiosity: how many young adults nationwide live in a persistent vegetative state? what percent of them recover? How many facilities exist nationwide that care for young adults in vegetative state?
These are excellent questions. Estimates I have seen indicate that between 10,000-25,000 people exist in a vegetative state in the United States. Exact numbers are hard to determine because of disagreement about diagnosis, the relative rarity of the condition, and the fact that people with brain injury may "progress" out of a vegetative state. I am unaware of any statistics on the number of facilities that care for patients in a "vegetative state." Partly, this would depend upon whether you included trauma hospitals, or whether you are only considering long-term facilities of patients in persistent vegetative states.