Coma natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3] Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S.[4]

Natural History

Outcomes range from recovery to death. Comas generally last a few days to a few weeks. They rarely last more than 2 to 5 weeks but some have lasted as long as several years. After this time, some patients gradually come out of the coma, some progress to a vegetative state, and others die. Some patients who have entered a vegetative state go on to regain a degree of awareness. Others remain in a vegetative state for years or even decades (the longest recorded period being 37 years). [1]

The outcome for coma and vegetative state depends on the cause, location, severity and extent of neurological damage. A deeper coma alone does not necessarily mean a slimmer chance of recovery, because some people in deep coma recover well while others in a so-called milder coma sometimes fail to improve.

People may emerge from a coma with a combination of physical, intellectual and psychological difficulties that need special attention. Recovery usually occurs gradually — patients acquire more and more ability to respond. Some patients never progress beyond very basic responses, but many recover full awareness. Regaining consciousness is not instant: in the first days, patients are only awake for a few minutes, and duration of time awake gradually increases.

Predicted chances of recovery are variable owing to different techniques used to measure the extent of neurological damage. All the predictions are based on statistical rates with some level of chance for recovery present: a person with a low chance of recovery may still awaken. Time is the best general predictor of a chance of recovery: after 4 months of coma caused by brain damage, the chance of partial recovery is less than 15%, and the chance of full recovery is very low.[2][3]

The most common cause of death for a person in a vegetative state is secondary infection such as pneumonia which can occur in patients who lie still for extended periods.

Occasionally people come out of coma after long periods of time. After 19 years in a minimally conscious state, Terry Wallis spontaneously began speaking and regained awareness of his surroundings.[4]

A brain-damaged man, trapped in a coma-like state for six years, was brought back to consciousness in 2003 by doctors who planted electrodes deep inside his brain. The method, called deep-brain electrical stimulation (DBS) successfully roused communication, complex movement and eating ability in the 38-year-old American man who suffered a traumatic brain injury. His injuries left him in a minimally conscious state (MCS), a condition akin to a coma but characterized by occasional, but brief, evidence of environmental and self-awareness that coma patients lack. [5]


  • Patient may remain in coma for an extended period
  • Death


Some patients with coma can recover, while others may keep in a vegetative state. The prognosis depends on:

  • The underlying causes
  • The severity
  • The site of neurological damage


  1. According to the Guinness Book of Records, the longest period spent in coma was by Elaine Esposito. She did not wake up after being anaesthetized for an appendectomy on August 6, 1941, at age 6. She died on November 25 1978 at age 43 years 357 days, having been in a coma for 37 years 111 days.
  2. Clinical predictors and neuropsychological outcome...[Acta Neurochir (Wien). 2004] - PubMed Result
  3. brain injury .com | Coma traumatic brain injury - Brain Injury Coma
  4. Mother stunned by coma victim's unexpected words -
  5. "Electrodes stir man from six-year coma-like state". Cosmos Magazine. 02 August 2007. Check date values in: |date= (help)

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