On the other hand, the function of the cerebral cortex of the cerebral cortex may be disturbed by metabolic changes such as hypoglycemia (low blood sugar level), hepatic and renal insufficiency, or diabetic ketoacidosis (with high blood sugar levels), as well as other toxic mechanisms. In the article "Coma and its degrees, the reasons for its occurrence" you will find very useful information for yourself.
• Processes that affect the brainstem directly, and disrupt the function of the BPF, such as hemorrhages in the brain stem, tumors or abscesses, or the effects of sedatives.
• Processes that damage the brain stem indirectly, that is, leading to its compression and damage to the VRF. These are, for example, a blood clot causing a brain displacement and prolapse of the temporal lobe next to the brain stem, or a tumor or abscess, leading to an increase in intracranial pressure.
Other causes of coma
In general, excluding damage to the head and other neurosurgical diseases, about 40% of coma cases are caused by a drug overdose, often in combination with alcohol. Of the remaining 40%, patients underwent cardiac arrest, 33% had a stroke and about 25% were coma due to metabolic disorders or infections, acute coma is an emergency pathology, in which case the initial management is identical to the management of other patients in a critical condition.The first step is always the basic resuscitation measures to ensure eniya airway patency to allow oxygen delivery, it may require the patient's endotracheal tube intubation and mechanical ventilation and blood circulation is maintained monitored blood pressure..
Further tests
If the cause of the coma is not clear, further tests are required. These include analyzes of the chemical composition of blood and urine, screening for drugs and toxins.
Chronic vegetative state
Some survivors after a coma fall into a chronic vegetative state (HVS). These patients breathe independently and have periods of opening and closing the eyes, which correspond to the cycle of sleep and wakefulness. They may have some primitive reflex reactions to external influences, such as sucking and grasping. However, patients in CVC do not show signs of awareness of themselves or their environment, nor of other higher nervous activity - they do not talk, communicate, or show any arbitrary reactions. In this condition, patients can live for many years. Pathologic anatomical studies of deceased people who were in XIV, revealed severe damage to the cerebral cortex (this area is responsible for higher nervous activity), but the preservation of the brain stem, which allowed to maintain basic physiological functions without the presence of consciousness.
Ethical considerations
Chronic vegetative state is not only a medical problem, but also an ethical one. Caregivers or relatives of some patients with chronic heart failure sometimes feel that this condition is so hopeless and depressing that they would prefer to turn off systems that support the patient's life by letting him die. Others consider such actions unethical. The choice is further complicated by the fact that there is no generally accepted opinion on the question of whether there are some signs of higher nervous activity and communication, even even if some patients are in general in the HVS, with a more thorough examination of patients in a chronic vegetative state. The ability to artificially maintain respiration and circulation in the intensive care unit leads to the fact that some patients are thus kept in hospitals without signs of brain functioning. This state of complete and irreversible absence of any activity in the brain and brainstem is traditionally called "brain death". However, at present, doctors prefer the term "death of the brainstem," as it became clear that the death of the brainstem is equivalent to the death of the brain as a whole.
Diagnosis of brain stem death
Diagnosis of brain stem death is carried out in accordance with the standard procedure, which uses tests designed to confirm the loss of normal brain stem function. Demonstration of a complete lack of brain stem function serves as an adequate confirmation that recovery will not follow. If a patient who meets the criteria for the death of the brainstem continues artificial ventilation and general intensive therapy, the heart will stop naturally in a few days.