Coma: Causes, Treatments, and Recovery in Elderly Patients

Coma scale score of 4?

My mother is 86 years old.
After a nap on January 8, she could not be awakened.
That evening, her blood sugar was measured at 183, her blood oxygen level was 89, and her blood pressure was normal.
On January 19, she still could not be awakened in the morning, and her blood sugar was measured at 163.
We rushed her to the emergency room, where she presented with a fever, and her blood sugar had dropped to a level that could not be detected by the glucose meter.
She had undergone cervical spine debridement surgery for a cervical spine abscess on November 3 of last year, and after two months of antibiotic treatment, her infection markers returned to normal, allowing her to be discharged.
However, just 11 days after returning home, she suddenly fell into a coma.
She stayed in the emergency room for 8 days, during which the hospital suspected an infection but believed it should not have caused the coma.
They performed MRI scans of the cervical spine and head, EEG tests, cerebrospinal fluid analysis, and even an abdominal CT scan, but they could not find a cause for the coma.
Eventually, she was admitted to the infectious disease department for treatment of the infection.
Initially, after being transferred to the ward, she would occasionally open her eyes spontaneously, make groaning sounds, and turn her gaze toward sounds, although her expression was vacant.
However, in the past few days, her infection markers rose again, and after switching to a stronger antibiotic, she has returned to almost never opening her eyes, and her groaning has decreased.
She has been experiencing diarrhea as a side effect, and pressure sores have developed on her buttocks, which are bleeding.
The doctors have stated that they are currently focusing on treating the infection, and they will address the coma issue once the infection markers normalize and she can be referred to other specialists.
We are very concerned about missing the critical treatment window.
My mother has been in a coma for 26 days, and her edema is severe, but the doctors are only treating the infection with antibiotics.
We really want to ask, for a patient in such a coma, are we just supposed to wait aside from antibiotic treatment? Are there no more aggressive treatment options available? Given the current severe pandemic situation, family members cannot visit, making it even harder to meet with doctors, and we are truly in the dark about my mother's condition.
When we call the doctors, they indicate that they are only addressing the infection, and regarding the coma, they say they will reassess once the infection is under control.
Dr.
Jiang, could you please tell us if this approach is correct? Are there no other more proactive methods to address the coma? Based on my mother's condition, what are the chances of her waking up? How long do comas typically last? We sincerely request your response.
Thank you.

Vicky, 40~49 year old female. Ask Date: 2022/02/14

Dr. Jiang Junyi reply Neurology

Dear Ms.
Vicky,
You mentioned, "Doctors only treat infections with antibiotics.
I really want to ask, for a comatose patient like this, do we just have to wait aside from antibiotic treatment? Are there no more aggressive treatment options?" In clinical practice, the most important aspect is bedside rehabilitation to reduce limb spasticity.
Some case reports suggest the use of out-of-pocket traditional Chinese medicine adjunctive therapies or hyperbaric oxygen therapy.
Hyperbaric oxygen therapy can increase the partial pressure of oxygen in brain tissue during rehabilitation for brain injuries, thereby improving tissue hypoxia and enhancing oxygen content in ischemic areas, gradually restoring brain function.
Thank you for your question, and feel free to discuss any related issues further!
Wishing you good health,
Dr.
Jiang Junyi
Peach Blossom Medical Center

Reply Date: 2022/02/14

More Info

Coma in elderly patients is a complex medical condition that can arise from various causes, including infections, metabolic imbalances, neurological disorders, and more. In your mother's case, her recent history of cervical spine surgery and subsequent infection raises significant concerns, particularly given her advanced age of 86.
The initial step in managing a patient in a coma is to identify the underlying cause. Infections, especially in elderly patients, can lead to altered mental status and coma. The fact that your mother has been treated with antibiotics suggests that the medical team is actively addressing a potential infectious source. However, it is crucial to recognize that the treatment of the underlying infection may take time, and the patient's response can vary significantly based on their overall health and the severity of the infection.

In your mother's situation, it is understandable to feel anxious about the duration of her coma and the potential for recovery. Coma can last for varying lengths of time, depending on the cause and the individual patient's health. Some patients may regain consciousness within days, while others may remain in a comatose state for weeks or even longer. The prognosis for recovery often depends on the duration of the coma, the underlying cause, and the patient's overall health prior to the event.

While the medical team is currently focused on treating the infection, it is essential to consider supportive care measures that can enhance recovery. These may include:
1. Nutritional Support: Ensuring that your mother receives adequate nutrition, either through enteral feeding (via a tube) or parenteral nutrition (intravenous), is crucial for her recovery.

2. Physical Therapy: Once her condition stabilizes, initiating physical therapy can help prevent complications such as muscle atrophy and pressure ulcers, especially given her current state of immobility.

3. Occupational Therapy: This can assist in maintaining her functional abilities and preparing for rehabilitation once she regains consciousness.

4. Neurological Monitoring: Continuous monitoring of her neurological status is vital. If there are any changes in her responsiveness, these should be communicated to the medical team immediately.

5. Pain Management: Ensuring that she is comfortable and pain-free is essential. If she is experiencing discomfort, appropriate pain management strategies should be employed.

6. Family Support and Communication: It is important to maintain open lines of communication with the healthcare team. If you have concerns or questions, do not hesitate to reach out to them. Family presence and support can also be beneficial for the patient, even if direct visitation is limited.

Regarding the concern about missing the "golden hour" for treatment, it is essential to understand that while early intervention can be critical in some cases, the treatment of infections and the management of comatose patients often require a more extended approach. The medical team will likely reassess her condition once the infection is under control, which may provide more clarity on her neurological status and potential for recovery.

In summary, while the current focus is on treating the infection, it is crucial to ensure that your mother receives comprehensive supportive care. Recovery from a coma can be a gradual process, and while it is difficult to predict outcomes, maintaining hope and advocating for her care is essential. If you feel that her needs are not being met, consider discussing your concerns with the healthcare team or seeking a second opinion from a specialist in neurology or geriatrics.

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