Bade accheRecently the show Bade Acche Lagte Hain saw the lead protagonist Priya Kapoor go into a coma after a near fatal car accident. Considering not many of us know much about the condition except from what we see in the movies, here are ten facts about a coma that you should know:

Fact#1: A coma is not a persistent vegetative state

A coma is a state where a person is alive but cannot respond to external stimuli. A persistent vegetative state, which usually follows a coma  is one where the person is not aware about their surroundings and has lost all cognitive and neurological function. In both these cases the person has basic functions active like breathing and circulation.

Fact#2: Coma can be caused by more than just trauma

A person may go into a coma due to many reasons like a severe brain trauma (like head injuries), swelling of the brain, bleeding within the brain, stroke, blood sugar fluctuations (also known as hyperglycaemia or hypoglycaemia), infections, oxygen deprivation, seizures and due to some toxins. In certain cases, a coma may be chemically induced to help a patient’s body heal completely after a severe trauma. (Read: Hrithik Roshan brain surgery: What is chronic subdural haematoma?)

Fact#3: The outcome or prognosis depends on the type of coma

The type of coma can be divided into five categories based on the type of injury sustained and the level of consciousness the person exhibits. When the coma is caused due to an infection or the build-up of some toxins in the body it is usually termed as toxic-metabolic encephalopathy  and in  most cases this type of coma can be reversed if the causative factor is rectified. An anoxic brain injury is where the brain does not get enough oxygen. Here, the cells die leading to the person going into a coma. This may occur in patients who suffer a heart attack, stroke, asphyxiation, drug overdose or poisoning. A person may slip into a persistent vegetative state, where he/she is unresponsive but will have breathing, circulation and a sleep-wake cycle (where the non-cognitive functions remain intact). A rare type of coma is known as the locked-in syndrome, where the person is completely paralyzed, except for his/her eye muscles. The person is aware of his or her surroundings and can move his/her eyes, but cannot perform any functions. And the last type is known as brain death where the brain dies and there is no noticeable brain function. This is usually the result of a severe head injury. (Read: Emergencies in diabetes – do you know enough? (expert speak))

Fact #4: Being in a coma does not mean being completely unresponsive

Patients in a coma are not always unresponsive, some can move their eyes, can breathe on their own and many may even open and close their eyes in response to some stimuli. So the scene of a patient lying absolutely still in a hospital bed might not be the most accurate description. 

Fact#5: A comatose patient might be aware of his/her surroundings

While some patients may not be able to hear anything while in a coma, others have been known to hear and remember whatever was spoken. Some even remember and reiterate the happenings once they regain full function. That is why it is essential that the patient’s family and medical staff keep a tab on what they speak around the patient.

Fact#6: The longer the person stays in a coma, the worse their prognosis

A person in a coma suffers brain damage, and this cell death only increases with the amount of time they are unconscious. While those who regain consciousness early might have minimal impairments,  others might have some long term disabilities.

Fact#7: A person does not just ‘simply’ wake up

If you have grown on regular Bollywood masala, a person goes back to his life immediately after a coma. This may not be true. Medically it is believed that a person starts to make tentative movements or tries to communicate when they have emerged from a comatose state. Further, the person then goes into PTA or Post Traumatic Amnesia, where they might be partially awake, be confused about the day and time and not know where or who they are. In such a situation a doctor will usually do a scan to confirm the diagnosis of PTA and see if there is any residual brain damage. 

Fact#8: A coma may last for as long as a few days or years

Depending on the extent of the damage and type of injury, a person may stay in a coma for a few days or even years. The standard time in a coma is expected to be about two to four weeks.  While, it is common to see the silver screen portray a person remaining in a coma for a number of years while everything changes around them, it is possible to see real people come out of the condition in the matter of weeks. In the case of coma due to physiological conditions, the patient is most likely to recover once the causative factor is reversed.

Fact#9: The depth and duration can be measured

When a person goes into a coma, a doctor can measure the depth of the state and the amount of time they are likely to remain in that state. This is done by using two scales known as the Glasgow Coma Scale (GCS), where the doctor tests the eye movements, response to stimulus and verbal responses of the person to determine his/her state. The other scale is the Rancho Los Amigos Scale which measures the all round function of the person and his/her brain.

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