Stroke-Induced Comas: Recovery And Hope For Patients

A stroke is a life-changing event that can bring about several challenges, including the possibility of a coma. During a coma, an individual is in a state of prolonged unconsciousness, unresponsive to their environment, and unable to be awakened by any external stimulation. While in a coma, the body continues to function, but complications can occur, such as urinary tract infections, pneumonia, bed sores, and blood clots. The recovery from a stroke-induced coma depends on various factors, including the severity of the stroke, the location of the stroke in the brain, and the overall health of the individual. While some individuals may recover within a few minutes to a few weeks, others may experience long-term disabilities or even death.

What is a stroke-induced coma?

A stroke-induced coma is a prolonged state of unconsciousness caused by a stroke. During a coma, a person is unresponsive to their environment and cannot be awakened by any stimulation, including pain. They are alive and look like they are sleeping, but their brain activity is minimal.

A stroke occurs when the blood supply to the brain is disrupted, killing brain cells. This can happen due to a clogged artery in the brain (ischemic stroke) or uncontrolled bleeding from a ruptured artery in the brain (hemorrhagic stroke). When the blood supply to the brain is affected, a wide variety of secondary effects and complications may occur, including a coma.

During a stroke-induced coma, the person is completely unresponsive to their surroundings and lacks a normal sleep-wake cycle. They cannot be woken up and are unable to purposefully react to anything in their environment. They will not respond to sound, pain, touch, or light, and cannot initiate any voluntary actions, such as blinking or squeezing a hand upon command.

The period of a stroke-induced coma rarely lasts longer than four weeks. However, in severe cases, a coma can last for years. While in a coma, the person's body continues to function, but they are unable to eat or drink and must be provided with nutrition and fluids through a feeding tube. They also require supportive care to prevent complications such as pressure injuries (bed sores), bladder and bowel control issues, and muscle and joint contractures.

The prognosis for a stroke-induced coma is uncertain, and it is impossible to know if or when someone will wake up. However, recovery is possible, and there have been cases of individuals regaining consciousness after being in a coma for years. The first year of recovery typically sees the most significant improvements, and rigorous rehabilitation, including physical, occupational, and speech therapy, is crucial for maximizing the chances of recovery.

What are the chances of recovery?

The chances of recovery from a stroke-induced coma vary from person to person and depend on several factors, including the severity of the stroke, the location of the stroke, and the overall health of the individual. While some people may recover within a few minutes to a few weeks, others may remain in a coma for longer periods or even progress into a persistent vegetative state.

During a coma, an individual is in a prolonged state of unconsciousness and unresponsiveness to their environment. They are alive and appear to be sleeping, but cannot be awakened by any external stimulation, including pain. A coma is typically caused by an injury to the brain, which can be due to increased pressure, bleeding, loss of oxygen, or a buildup of toxins. In the context of a stroke, this often involves a disruption in the blood supply to the brain, resulting in oxygen deprivation and potential brain damage.

The first few weeks and months after a stroke are critical for recovery. About 10% of stroke survivors fall into a coma due to intensive medical intervention during the early onset of the stroke. This period is crucial for stabilising the patient's condition and preventing further complications and damage. During this time, individuals often undergo acute care and intensive rehabilitation, which includes rigorous physical, occupational, and speech therapy.

The majority of recovery typically occurs during the first year after a stroke. Approximately 75% of stroke sufferers continue to recover during this period, and more than 50-75% of survivors will eventually be able to walk independently within six months of the stroke. However, it is important to note that recovery can continue beyond the first year, and further rehabilitation may be necessary.

The prognosis for individuals in a stroke-induced coma can be challenging to predict, and each case is unique. The longer an individual remains in a coma, the more unfavourable the prognosis tends to be. Even with good care, a severe stroke may result in serious disabilities or impair the individual's ability to live independently. In some cases, a stroke can be severe enough to cause death.

While the chances of recovery from a stroke-induced coma can vary, there have been cases of individuals making remarkable progress even after being in a coma for an extended period. Family members and loved ones can play a crucial role in promoting recovery by providing sensory stimulation and emotional support. Additionally, advanced therapies and innovations, such as neurostimulation techniques and robotics-assisted therapies, offer promising avenues for improving recovery prospects.

What are the signs of someone coming out of a coma?

While in a coma, a person is in a prolonged state of unconsciousness and is unresponsive to their environment. However, they are alive and look like they are sleeping.

A coma rarely lasts longer than four weeks. Once a survivor regains a sleep-wake cycle, they have progressed to the next stage of consciousness called post-coma unresponsiveness. This is typically diagnosed after the individual has been in this state for at least four weeks.

There are four stages to a coma, and there is no way of knowing how long anyone will be in any stage. Stage I is the coma itself. This is followed by:

Stage II:

In this stage, the person may start responding to some commands, such as to open their eyes. They may react to sound, and if they are in pain, their arm may flinch or they may try to pull away.

Stage III:

This stage is when the person is more awake but is confused and may be agitated. You may see a personality change. A normally sweet, quiet person may start to yell or swear and try to hit out.

Stage IV:

This last stage is when the person is completely awake and can do simple routine things, such as sitting up and eating. However, if the recovery is only partial, they may have difficulty performing these tasks.

As someone recovers from a coma, doctors frequently use the Ranchos Los Amigos Scale to measure their progress. The full name is The Rancho Los Amigos Scale. They may use it alone or along with the Glasgow Coma Scale.

The original Ranchos Scale had eight stages. The revised one, currently in use, has 10:

• There is no response to stimulation, such as rubbing on the sternum.
• There are some responses, but they are either inconsistent or the same response to any type of stimuli.
• The responses are a bit more consistent, and the person can respond to family and friends.
• The person is agitated and confused. They have no short-term memory.
• The person remains agitated but can respond to simple commands. They cannot start a task on their own but can complete a simple one if told what to do. Memory is still bad.
• Confusion remains but it's not as bad, and they are able to follow simple instructions consistently. They may be able to perform familiar simple tasks but not new ones. They don't yet understand that they have some problems, and this can be a safety risk.
• Much less help is needed. The person can perform the tasks they did before they went into a coma but still may be confused sometimes. They understand that they were in a coma but still may not understand their limitations and can still be a safety risk. They might start to take part in social events.
• They are no longer confused and can carry out many tasks. They may understand their limitations, respond properly to different events, and have an improved memory. At this point, however, they may start to get depressed, anxious, or angry.
• They're much more independent now but can't always see ahead to anticipate problems. They may have a low frustration threshold and be depressed.
• At this point, the person is almost completely independent, able to make decisions, and manage on their own.

The Glasgow Coma Scale is another tool used by medical practitioners to measure a patient's level of consciousness. This diagnostic tool mentions three key areas used to measure a patient's level of responsiveness: eye response, verbal response, and motor response.

Some of the signs of someone coming out of a coma include:

• The person may be able to whisper a few words or slowly blink on command.
• Pupillary reactivity, which refers to the pupil’s ability to shrink in response to light.
• The oculocephalic response, wherein the eyes turn towards the opposite direction when the head is turned.
• The gag reflex can be elicited by placing cotton at the back of the patient’s throat or an endotracheal tube if the intubation process is done.

What is locked-in syndrome?

Locked-in syndrome (LIS) is a rare and serious neurological disorder that occurs when there is damage to the brainstem, usually from a stroke. It is sometimes referred to as pseudocoma.

People with locked-in syndrome are conscious, alert, and have their normal cognitive abilities, but they are unable to speak or move any muscles other than those that control eye movement. They can usually communicate through blinking or eye movements and can lead meaningful lives with the help of assistive technology.

The condition is often initially mistaken for a coma, and diagnosis can be difficult. It is typically identified when a family member or carer notices small signs of awareness.

Locked-in syndrome is classified into three types:

• Classical locked-in syndrome: This condition leads to complete loss of mobility, though people retain their hearing ability.
• Incomplete locked-in syndrome: This is similar to the classical form, but the individual retains some sensations and the ability to move certain body parts.
• Total immobility locked-in syndrome: People with this condition have complete body paralysis, including eye movements, but retain cognitive abilities.

Locked-in syndrome is caused by damage to a specific part of the brainstem called the pons. The pons is a broad horseshoe-shaped mass of nerve fibres that connects the medulla oblongata (the lowest portion of the brainstem) with the cerebellum, which plays a vital role in physical movement and coordination.

There is no cure or specific treatment for locked-in syndrome, other than treating the underlying cause and preventing further complications. Management of the condition includes supportive therapy for breathing and feeding, as well as communication training to help individuals communicate using eye movements and blinking.

How can you support someone in a coma?

Supporting a family member or friend dealing with a brain injury can be distressing and overwhelming. Here are some ways you can help:

At the Hospital

• Offer to visit the patient in the hospital to give the close family a break.
• Help with essential household tasks, such as shopping, laundry, cleaning, and walking pets.
• Prepare simple meals that can be easily reheated.
• Turn lights on/off, check the heating, put the bins out, etc.
• Take children to school.
• Offer to drive family members to and from the hospital.
• Be mindful that the family may need space, so don't be offended if they decline your offers of help.

Communication

• Understand that the family may be too busy or too overwhelmed to respond to your messages or calls.
• Wait for the next of kin to get in touch, but don't be afraid to send a message of support.
• Offer to be the point of contact for other family members and friends to reduce the pressure on the next of kin.
• Continue to reach out and offer to meet up, even if the patient has changed a lot.

Emotional Support

• Join a support group for friends and family of stroke patients to learn from others in similar situations.
• Be respectful and kind to the patient and other family members.
• Address the patient in the first person, as if they can hear you, and talk about things that may make them want to wake up.
• Play recordings of happy memories and play their favourite music to the patient.
• Talk to other patients in the hospital who may be alone.

Working with Hospital Staff

• Be extremely polite and kind to hospital staff.
• Bring gifts, snacks, and coffee for the staff.
• Ask the nurses and doctors how you can be helpful, and respect their requests.
• Take on some light daily chores, such as refilling water pitchers or straightening the patient's sheets, to make the staff's jobs easier.

Frequently asked questions