Delayed Coma – Loss of Consciousness
As of 2013, there is little remaining controversy in the peer reviewed literature that a loss of consciousness at the time of an injury, is not a requisite for the diagnosis of a concussion. Yet, there are still countless neurologists who will swear to something similar in depositions when hired by insurance companies or defense attorneys. Oddly, such statements are so flat out wrong, that it is easy to impeach with the simple example of the delayed loss of consciousness or delayed coma which occurs in a significant number of severe brain injury cases, where the brain damage occurs as a result of increased intracranial pressure. As the pressure increases in can result in a delayed coma.
A loss of consciousness (LOC) or delayed coma may occur after discharge from the hospital, especially if the detailed analysis necessary to diagnose a subtle brain injury is not undertaken. In cases of hematoma, hemorrhage or swelling, the loss of consciousness may occur after discharge, as a result of the increased pressure. It may occur when the patient has been discharged and gone to bed.
Head Injury Discharge Instructions
One of the most cornerstones of modern head injury treatment has been the “head injury discharge instructions” given to almost anyone who suffered a potential brain injury, for decades. The entire focus of such discharge instructions is to monitor for decreasing levels of consciousness and neurological function, after discharge.
So when the sub-acute diagnosis of permanent brain damage is being made, one of the inquires is whether any of the issues from the Head Injury Discharge Instructions, occurred on the day of discharge. Did the relatives or friends have difficulty waking the patient?