Approach to a child with depressed level of consciousness and coma

Author(s): Amit Sarnaik, Nirmala B Bhaya and Prashant V Mahajan

Altered mental status and coma can be considered as an acute neurological emergency characterized by significant brain impairment, necessitating a rapid, methodical approach to evaluation and treatment. There are several, diverse causes of coma, which makes an exact diagnosis challenging. Regardless of the etiology, coma is suggestive of a primary insult to the brain, which, if left untreated, can rapidly progress to secondary injury, and thus result in substantial morbidity and even mortality. It is imperative to rapidly recognize this entity, institute appropriate treatments and improve prognosis. In this article, we review the pathophysiology of coma and its causes to get a basic understanding of this entity. We also discuss the various diagnostic and management approaches for timely recognition and treatment of this life-threatening emergency. In addition, we present some prognostic indicators in a comatose child.