Introduction and Definition

Coma is difficult to define because brain failure exists along a spectrum of unresponsiveness. Both the alerting and the content portions of consciousness are impaired in coma. The definition of an eyes-closed state with inappropriate responses to environmental stimuli is still a useful one. A variety of terms are used to describe patients with lowered levels of consciousness; delirium is discussed in some detail above. Stupor, obtundation, and lethargy are so inexactly used that they have little meaning. A description of the patient's responses to stimuli at one moment in time is still the best assessment of level of consciousness. Though originally designed for statistical analysis of head-injured patients, the Glasgow coma scale is widely used in many clinical situations. Its advantages include a simple scoring system and assessment of separate verbal, motor, and eye-opening functions. Its disadvantages include lack of assessment of hemiparesis or other focal motor signs and lack of testing of higher cognitive functions.

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