Stupor and Coma
Stupor and coma describe two different altered states of consciousness. Coma is the deeper of the two.
What Are Stupor and Coma?
Stupor and coma describe two different altered states of consciousness. Stupor is a state of unconsciousness from which an individual can only be roused with a forceful, physical stimulus. Coma is an even deeper level of unconsciousness, during which the individual does not have any voluntary movement or behavior. When in a coma, an individual cannot be aroused with verbal, physical, or even physically painful stimuli, and even basic reflexes may be lost.
What Causes Stupor and Coma?
Stupor and coma may stem from the same kinds of disorders. In each case, the disorders affect the functioning of the brain's nerve cells, causing them to respond very slowly or to cease responding. Common causes include liver disease, kidney failure, thyroid disorders, hypothermia (abnormally, dangerously low body temperature), hyperthermia (abnormal, dangerously high body temperature), toxic exposures/poisonings, excess alcohol, drugs such as sedatives or opioids, severe dehydration and electrolyte imbalances, drug reactions, infection (particularly in the elderly), direct trauma (injury) to the brain, strokes, tumors, aneurysms, seizures, brain abscesses, heart attacks, metabolic problems (high blood glucose, low blood glucose, excess or deficient blood sodium), and oxygen deprivation (asphyxiation).
Who Is Likely to go into a Stupor or Coma?
Given the right circumstances, anybody can suffer from stupor or coma, although the elderly are particularly vulnerable. The same level of illness, trauma, or toxic exposure that a younger person might be able to weather successfully, may well produce stupor or coma in an older individual.
What are the Symptoms of Stupor and Coma?
The most notable symptom of stupor is the individual's inability to respond to normal stimuli. Instead, shouting, shaking, or painful stimuli are necessary to provoke a response. The individual's eyes may be open, but clearly not focusing. In coma, intense stimuli do not provoke a response, and the eyes are closed.
Other features of stupor and coma that may be present include abnormal breathing patterns; unusual contraction or flaccidity of muscles, resulting in odd positioning of limbs and/or head; abnormal dilatation or contraction of the pupils of the eyes; and odd eye movements.
How Are Stupor and Coma Diagnosed?
Impaired consciousness is quite evident upon initial observation, although determining the level and the cause of impairment requires further investigation. Differentiating between stupor and coma requires simple maneuvers to see whether the individual will arouse to intense stimuli (as in stupor) or whether no arousal is possible (as in coma). Physical examination will also be performed to look for other clues that may point to the reason for the impaired consciousness.
If coma is diagnosed, a rating system called the Glasgow Coma Scale (GCS) may be used to assess the depth of the coma, to monitor the individual's progress over time, and to roughly ascertain the individual's overall prognosis. The Glasgow Coma Scale uses a point system to evaluate three categories of functioning: opening of the eyes, using words or voice to respond, and motor response (moving a part of the body to respond). The highest level of functioning is assigned to individuals who spontaneously open their eyes, can give appropriate verbal responses to questions, and can carry out a simple command to move a part of their body. A GCS score of 3-5 may suggest fatal brain damage; a GCS score of eight or more suggests that the chance of recover is good.
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