Coma (cont.)
What are the causes of Coma?
Generally, coma is commonly a result of trauma, bleeding and/or swelling
affecting the brain. Inadequate oxygen or blood sugar (glucose) and various
poisons can also directly injure the brain to cause coma.
Trauma
Minor head injuries can cause brief loss of consciousness, but the
brain is able to turn itself back on. Similarly, patients with
seizures become
unconscious - but gradually waken relatively quickly. Those people who cannot
respond after head injury usually have had significant force applied to their
head and brain.
The skull is a rigid box that protects the brain. Unfortunately, if the brain
is injured and begins to swell (edema), there is no room for the additional
fluid. This
causes the brain to push up against the sides of the skull and it then
compresses. Unless the pressure is relieved, the brain will continue to swell until it pushes down onto the brain steam,
which then damages the RAS, which subsequently affects blood pressure
and breathing control centers.
The affect of trauma on the brain is not predictable. It may or may not cause
significant injury. If the brain is shaken, shear
injury may occur, where the nerve connections within the brain are damaged. Coma
may occur even with a normal CT scan in this situation. Similarly, head trauma may
cause swelling of the brain without any bleeding, and coma may be the result.
Head trauma can cause different types of brain injury. The injury can occur
to the brain tissue itself or may cause bleeding to occur between the brain
and the skull. Computerized Tomography (CT) of the head can identify most
bleeding from trauma.
Bleeding (Hemorrhage)
Intracerebral hemorrhage (intra= within + cerebral=brain +
hemorrhage=bleeding) may be small, but it is associated swelling that may
cause damage.
Next: Epidural, subdural, and subarachnoid hemorrhages »
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