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Coma After Stroke: What It Means & How to Maximize Chances of Recovery

stroke patient lying in hospital bed surrounded by family members

When a loved one falls into a coma after stroke, it can be a distressing time.

It’s impossible to know if or when someone will wake up from a coma. To help cope with this uncertainty, it’s crucial to do your research and also find emotional support for yourself.

You’re about to learn some statistics about coma after stroke, which can hopefully paint a picture of what to expect. Every stroke is different, so it’s impossible to know exactly what will happen. Still, there are patterns worth noting.

Here’s everything we know about coma after stroke:

What does it mean to be in a coma?

When a stroke patient goes into a coma, they have entered a state of unconsciousness. They have minimal brain activity, cannot be woken up, and cannot react to anything in the environment.

A patient in a coma will have closed eyes, won’t respond to sound or pain, and won’t have a normal sleep-wake cycle. Furthermore, they cannot initiate any voluntary actions.

While someone remains in a coma, there’s a chance that they can hear, but cannot respond due to the loss of voluntary actions.

Once a patient can move their eyes and regains a sleep-wake cycle, they have progressed from a coma to the next stage called post-coma unresponsiveness.

A tool used to measure levels of consciousness is called the Glasgow Coma Scale. During the hospital stay, doctors will use this scale to assess the level of responsiveness in the patient.

Quick summary: When stroke patients fall into a coma, they are completely unresponsive and lack a sleep-wake cycle.

What causes coma after stroke?

To understand why someone has fallen into coma after stroke, it’s important to know what causes a stroke to begin with.

A stroke occurs when the supply of blood to the brain is compromised. This can result from a clogged artery in the brain (known as ischemic stroke) or burst artery in the brain (known as hemorrhagic stroke).

When a stroke occurs, it can increase intracranial pressure, especially during a hemorrhagic stroke where blood begins to fill the areas between the brain and the skull.

Swelling in the brain, or cerebral edema, in particular is thought to increase the risk of coma after stroke. If surgery is required to stop the stroke, coma is also possible after the surgery is performed.

Quick summary: Coma is more likely to occur if the stroke creates excessive intracranial pressure and/or requires surgery.

What types of stroke lead to coma?

It’s generally understood that coma is more common after a massive stroke or stroke in the brain stem. Let’s take a deeper look at these two types of stroke and how they relate to coma.

First, massive strokes may result in coma due to the significant impact on the brain. They are more likely to result in swelling, intracranial pressure, and the need for surgery, which can result in coma.

Second, the brain stem houses the Reticular Activating System (RAS) which controls the arousal states of waking and sleeping.

According to Dr. Alejandro Rabinstein, when the RAS is damaged by stroke, it can lead to coma. One explanation is that, in order for a person to be awake, the RAS and at least one brain hemisphere must be functioning.

This does not mean that only massive stroke and brain stem stroke can lead to coma, but these types of stroke seem to carry a higher risk.

Every stroke is different, which means that every stroke will lead to different outcomes.

Quick summary: Coma is more common after a massive stroke or brain stem stroke.

How long can a person be unresponsive after a stroke?

It’s unknown how long a stroke-induced coma will last in any patient since every stroke is different. Coma can last several days to several weeks. In severe cases, it can last for years.

Previously, experts thought that individuals in long-term coma could not recover. However, recent research suggests that late recovery is possible thanks to the remarkable plasticity of the human brain.

If a patient recovers from a coma, they may regain consciousness slowly, moving through the stages of coma including a vegetative state and minimally conscious state. The eyes may regain movement first, and then other voluntary responses may slowly follow.

There is no doubt that waiting for a loved one to wake up from a coma can be distressing. The uncertainty can create anxiety and stress, making it important for loved ones to seek their own support during this time.

The good news is that there are steps you can take to maximize chances of recovery for your loved on in a stroke-induced coma. We will discuss those steps next.

Quick summary: Coma can last several days to several weeks. Not all patients survive, but recovery — even late recovery — is possible for some.

What can I do to help my loved one in a stroke-induced coma?

Although patients in a coma are unconscious, it’s possible that someone in a coma can still hear. Therefore, some of the best advice for helping someone in a coma is to talk to them.

While it’s not guaranteed that they can hear you, it’s worth the effort in the chance that they can. Plus, it can also be therapeutic for you as a loved one.

Another option includes coma arousal therapy. This is an intensive treatment that involves vigorous multisensory stimulation applied to the patient for up to 8 hours per day every day of the week.

Some studies are unable to demonstrate that coma arousal therapy actually helps. Other studies show that coma arousal therapy helps significantly shorten the duration of coma.

Although the limited studies have mixed results, it could be worth the effort if loved ones or caregivers have the resources to try it.

Quick summary: It’s helpful to talk to patients in a coma because they might be able to hear you.

What can I do if they wake up?

If your loved one wakes up from a stroke-induced coma, it’s time to prepare for the road to recovery ahead.

Because coma is more common after a massive stroke, it’s likely that your loved one has sustained significant side effects such as post-stroke paralysis. This means it’s important to start rehabilitation as soon as possible.

By participating in rigorous therapy, stroke patients can progress to make remarkable recoveries, thanks to the brain’s remarkable plasticity and ability to heal itself.

It can also be helpful to join a stroke support group to talk to other in similar situations.

We wish you the best of luck on the road to recovery.

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See how Susan is recovering from post-stroke paralysis

“I had a stroke five years ago causing paralysis on my left side which remains today.

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The therapy modality motivates me to use it daily and challenges me to compete against my earlier scores.

I heartily recommend it!-Susan, stroke survivor

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