Coma

Coma
Image of a comatose man unresponsive to stimuli
Specialty	Neurology, psychiatry
Symptoms	Unconsciousness
Complications	Persistent vegetative state, death
Duration	Can vary from a few days to several years (longest recorded is 42 years)

A coma is a deep state of prolonged unconsciousness in which a person cannot be awakened, fails to respond normally to painful stimuli, light, or sound, lacks a normal wake-sleep cycle and does not initiate voluntary actions.^[1] The person may experience respiratory and circulatory problems due to the body's inability to maintain normal bodily functions. People in a coma often require extensive medical care to maintain their health and prevent complications such as pneumonia or blood clots.^[2] Coma patients exhibit a complete absence of wakefulness and are unable to consciously feel, speak or move.^[3][4] Comas can be derived by natural causes, or can be medically induced.^[5]

Clinically, a coma can be defined as the consistent inability to follow a one-step command.^[6][7] It can also be defined as a score of ≤ 8 on the Glasgow Coma Scale (GCS) lasting ≥ 6 hours.^[8] For a patient to maintain consciousness, the components of wakefulness and awareness must be maintained. Wakefulness describes the quantitative degree of consciousness, whereas awareness relates to the qualitative aspects of the functions mediated by the cortex, including cognitive abilities such as attention, sensory perception, explicit memory, language, the execution of tasks, temporal and spatial orientation and reality judgment.^[3][9] From a neurological perspective, consciousness is maintained by the activation of the cerebral cortex—the gray matter that forms the outer layer of the brain—and by the reticular activating system (RAS), a structure located within the brainstem.^[10][11]