There are hundreds of causes of coma as listed
below, so the following is an over-simplification that most comas are
caused by 2 major conditions:
#1. Trauma, or
physical injury -- this can be determined with MRI, etc.
#2. Biochemical,
drug, toxin-related due to imbalances of chemicals in the body --
this can be determined with blood/hormone tests.
For #1, if coma
persists, there may be internal bleeding that the MRI is not picking up.
If so, you'll need to push for more MRI-type tests. But they may resist
doing the extra tests because of the cost.
For #2, if coma
persists, they may be missing something in the blood/hormone tests. If
so, you'll need to push for more blood/hormone-type tests. But they may
resist doing the extra tests because of the cost.
Question: So, which
condition does you mother have? If the doctors don't know, you need to
push for more tests. Unfortunately, some tests may do more harm than
good, so ensure you understand the risks for any tests that are
performed.
You
mentioned that your mother has constant falls plus she has diabetes
and has had several mini-strokes. Plus, she had a fever,
where they gave her Tylenol? But what was the cause of the fever? An
infection maybe?
Constant
falls and mini-strokes can lead to some kind of damage to the brain
even though the MRI may not be showing it. A mini-stroke is a stroke
although not as dangerous -- but a series of mini-strokes can be just as
dangerous if ignored over time.
A
type of stroke, called an ischemic stroke, can also lead to a coma. This
stroke occurs when an artery that supplies the brain with blood is
blocked. The blockage starves the brain of blood and oxygen. If it is
very large, the person can fall into a coma.
In
people with diabetes, the body does not produce enough of the
hormone insulin. Because insulin helps cells use glucose for energy, a
lack of the hormone causes blood glucose levels to rise (hyperglycemia).
Conversely, when insulin isn't in the right proportion, blood sugar can
drop too low (hypoglycemia). If the blood sugar is either extremely
high or low, it can cause a person to fall into a diabetic coma.
Comas
can also be caused by brain tumors, alcohol or drug overdoses, seizure
disorders, lack of oxygen to the brain (such as from drowning) or
extremely high blood pressure.
A
person can become comatose immediately or gradually. If an infection
or other illness causes the coma, for example, the person might run a
high fever, feel dizzy or seem lethargic before falling into a coma. If
the cause is a stroke or severe head trauma, they can become comatose
almost immediately.
If a
person suffers severe head trauma (i.e. from a fall), the impact can
cause the brain to move back and forth inside the skull. The movement of
the brain inside the skull can tear blood vessels and nerve fibers,
which causes swelling in the brain (but the swelling may be undetectable
or overlooked). This swelling presses down on blood vessels, blocking
the flow of blood (and with it, oxygen) to the brain. The oxygen- and
blood-starved parts of the brain begin to die.
Some
infections of the brain and spinal cord (such as encephalitis or
meningitis) can also cause swelling in the brain. Conditions that cause
an excess of blood inside the brain or skull, such a skull fracture or a
burst aneurysm, can also lead to swelling and further brain injury.
Please
Note: In reality, coma survival rates are 50 percent or less,
and less than 10 percent of people who come out of a coma completely
recover from it. Comas as seen on TV can lead to
unrealistic expectations by the families and loved ones of people who
are in a real-life coma.
Bottom line: You need to
ask the doctors what is your mother's current diagnosis, and what is the
plan of treatment. Then, ask them what is her prognosis or
outlook for the future state of her health.
Also,
you need to find a health advocate in the hospital to help you (i.e. a
nurse), or someone not affiliated with the hospital (to get an honest
answer) -- maybe another doctor to give you a second opinion.
Questions
Here
are some questions that you should be able to answer. If you can't
answer them, seek the answers as soon as possible from the doctors and
hospital staff.
How
is your mother being treated by the doctors and the hospital? What kind
of care is she receiving?
What
doctors are treating your mother? cardiologist? neurologist?
endocrinologist? other specialty doctor?
Do
they all agree on her diagnosis? If not, you need to find out why.
Is
your mother totally unresponsive to external stimuli?
Does
your mother respond to stimuli, with reactions such as movement or
increased heart rate?
Can
your mother see, hear, touch, and taste, but cannot respond?
Does
she have a tube in her windpipe through the mouth, and hooked up to a
breathing machine, or ventilator?
Does
she have any other tubes or connections? If excess pressure in the
brain caused the coma, doctors can relieve it by surgically placing a
tube inside the skull and draining the fluid. A procedure called hyperventilation,
which increases the rate of breathing to constrict blood vessels in the
brain, can also relieve pressure. The doctor may also give the patient
medication to prevent seizures. If a drug overdose or condition such as
very low blood sugar is responsible for the coma, doctors attempt to
correct this as soon as possible. Patients with acute ischemic strokes
may undergo procedures or receive special clot-busting
medication in an effort to restore blood flow to the
brain.
Have
they given her imaging scans, such as magnetic resonance imaging (MRI),
or computed tomography (CT) scans, to look inside the brain and
identify a tumor, pressure, and any signs of damage to the brain tissue?
Have
they used an Electroencephalography (EEG) is a test used to detect
any abnormalities in the brain's electrical activity. This can also show
brain tumors, infections, and other conditions that might have caused
the coma.
If
the doctor suspects an infection such as meningitis, he may perform a
spinal tap to make the diagnosis. To perform this test, a doctor inserts
a needle into the patient's spine and removes a sample of cerebrospinal
fluid for testing.
Coma patients are susceptible to pneumonia and
other infections. Many comatose patients stay in the hospital's
intensive care unit (ICU), where doctors and nurses can continually
monitor them. People who are in a coma for a long time may receive
physical therapy to prevent long-term muscle damage. Nurses will also
move them periodically to prevent bedsores -- painful skin wounds caused
by lying in one position for too long.
Coma patients receive
nutrients and liquids through a vein or feeding tube so that they don't
starve or dehydrate. Coma patients may also receive electrolytes --
salt and other substances that help regulate body processes.
If
a coma patient continues to be dependent on a ventilator to breathe,
they may receive a special tube that goes directly into their windpipe
through the front of the throat (a tracheotomy). The tracheotomy tube
can be left in place for extended periods of time because it requires
less maintenance and does not injure the soft tissues of the oral cavity
and upper throat. Because patients who are in a coma can't urinate on
their own, they will have a rubber tube called a catheter inserted
directly into their bladder to remove the urine.
The
above list are some of the key ways that a coma patient is treated in a
hospital. Check to ensure your mother is receiving maximum care in
these areas.
And,
don't forget to review the highlighted areas below in bold yellow -- these are areas that you and/or
the doctors may want to review.