By Jonny Lupsha, Wondrium Staff Writer
Munira Abdulla woke up from 27 years of being comatose due to an accident, according to Sky News. Abdulla was age 32 when her car was struck by a school bus. The prognosis for patients who experience long-term comas is usually less favorable.
Munira Abdulla’s family came forward last week and said that she awoke last June from a coma that had kept her unconscious since 1991. Abdulla had been driving her son, Omar, then 4 years old, home from preschool in the city of Al Ain in the United Arab Emirates when a school bus struck her car. Omar fortunately escaped with minor bruising, but Abdulla fell into a coma and was transferred from one hospital to another over a period of time, finally remaining in Germany until she awoke and was medically cleared to return home. She now receives treatment in Abu Dhabi. Often, sensationalist stories, and fictional entertainment, skew our knowledge of what medically is involved during a coma and what a patient’s prognosis might be.
Coma Mythbusting—States of Consciousness
So what is a coma? Technically speaking, “a coma is a disorder of consciousness or wakefulness,” said Dr. Steven Novella, Assistant Professor of Neurology at the Yale Medical School. “In order to be both conscious and awake, one thing we know is that you need one of your hemispheres—one half of the cortex—to be functional. You also need your brain stem to be mostly functional.” The cortex is the thinking portion of your brain, which the brain stem constantly sends information to in order to keep it awake.
One of the biggest myths about comas is simply that the condition of being in a coma is one specific brain state. This myth says that either you’re fully unaware and unresponsive of your surroundings, sleeping deeply in a coma, or you’re wide awake and conscious. According to Dr. Novella, a coma is actually a continuum of various states. “We sometimes use the word ‘obtunded’ to refer to somebody who has a decreased level of consciousness, but is still conscious enough to interact with the environment and people,” he said. “Beyond that, there is a minimally conscious state. This is where someone is not awake, but they are barely able to show that they have some signs of consciousness—that they can respond to the environment.”
Dr. Novella explained that there is the “persistent vegetative state,” or PVS, which requires a patient to be absolutely unresponsive to any stimuli but still show brain function, and “brain death,” which some people confuse with PVS and refer to someone as “brain dead.” However, brain death means actual death.
Facts about Waking from Comas
In the movies and on television, doctors are portrayed as telling a comatose patient’s family just after the patient has had an accident or trauma whether or not the patient will wake up from a coma. “Within 48 hours of someone entering a coma because of trauma, or really any reason, prognosis is very uncertain,” Dr. Novella said. “We’ll rarely make predictions in the first 48 hours unless there is so much damage that it’s simply not possible.” However, by the third day of the coma, readings of the patient’s brain function can far better predict whether the patient will wake up.
The conditions of a coma patient upon waking are also less sunny than is often seen in entertainment. “Once there is a certain amount of damage that’s irreversible, patients are never going to wake up and lead a normal life,” Dr. Novella said. “This is where the real myth of waking from a coma comes from.”
“In addition, when you’ve been in a coma for months or years,” Dr. Novella said, “because of the kind of brain damage that can cause that length of time to happen, it’s also almost impossible to awake from the coma and be almost neurologically intact, like it is sometimes seen in the movies.”
Dr. Steven Novella contributed to this article. Dr. Novella is Assistant Professor of Neurology at the Yale School of Medicine. He earned his M.D. from Georgetown University and completed his residency training in neurology at Yale University.