An appendicoma is defined by a holistic loss of consciousness and the ability to communicate.
Furthermore, there is a bowel and bladder incontinence. Sleep and wakefulness are disturbed, but basal life functions such as circulation, respiration, and digestion still work. Patients can also sleep and occasionally react to stimuli. For outsiders, those affected awake, but this impression is largely deceptive.
The pathways between the cerebrum and the brain stem are severely destroyed. While the brain stem still works, the cerebrum function has a pronounced disorder. Some patients wake up at some point while others never regain a normal state of consciousness.
The coma or appalic syndrome is therefore a complex and very severe clinical picture, which is treated in the intensive care unit of a hospital.
The coma is always the result of very severe damage to the brain. The damage is often triggered by a craniocerebral trauma or an oxygen deficiency, which has been caused by a cardiac arrest.
Other causes of these neurological diseases are stroke, meningitis and brain tumors. Even neurodegenerative diseases, which include Parkinson's disease, for example, can trigger the apallic syndrome. In addition, there are cases in which an extreme persistent hypoglycaemia may lead to the condition coma.
Whatever the trigger, there is severe damage to the cerebrum. Frequently, other important brain regions are permanently damaged, so that a coma or the apallic syndrome is caused.
The so-called wake coma or apallic syndrome is characterized by an extensive standstill of communication options. The patient usually requires intensive care treatment when diagnosed. He has often survived an accident with severe brain injuries or has fallen into a wake coma due to other circumstances. Initially, he must be artificially ventilated and fed intravenously.
The wake coma usually occurs suddenly. Only in certain neurodegenerative diseases can the symptoms be gradual. A typical symptom is that the person concerned is awake. He has his eyes open, but they look into the void. Obviously, they do not realize what is happening around them. Whether there is no perception at all is debatable. Caregivers often experience that elevated blood pressure or other signals indicate some responsiveness.
Other symptoms include aphasia, incontinence, spasticity, or involuntary movement patterns. Reflexes and respiratory reflexes are typically preserved. At a later stage of the apallic syndrome, muscle shortening, muscle twitching, palpitations, sweats, or hypertension may occur.
These symptoms are interpreted as signs of a malfunctioning autonomic nervous system. Only in a few cases do patients wake up after years of waking humor. In most cases, decubitus develops due to prolonged lying. Long-term ventilation can cause pneumonia to death.
The diagnosis of a wake coma is clinical and usually lasts several weeks or months. Severe neurological deficiency syndromes must be uncovered. For this purpose, the apparatus diagnostics are used, which include magnetic resonance imaging, the electroencephalogram and evoked potentials.
They are used in combination, since none of these examination methods is suitable alone for a diagnosis. There must be a differentiation from other diseases such as locked-in syndrome and coma. If a coma has been detected, the relatives must adjust to a treatment success, which is less than 50%. A better prognosis is given when the coma is just beginning, the patient is young and there is a traumatic brain injury.
An improvement of the awake coma or apallic syndrome is unlikely, for example, if the brainstem reflexes are absent for more than 24 hours, no pupil reaction has been shown for three days or there is a massive cerebral edema on CT.
Patients who fall into a waking coma suffer from acute complications as well as long-term consequences, which often only become apparent after awakening. The typical problems include incontinence and bed-rest, usually associated with other consequences such as inflammation, sores and circulatory disorders. After awakening, the patient usually suffers from delirium, which can persist for several days to weeks.
With longer-lasting wax coma lasting mental symptoms are possible. A longer coma often has an impact on the psyche of the patient. It then comes to depressive moods, changes in personality or severe dissociative disorders.
Also, anxiety disorders can occur as part of an apallic syndrome. An existing vegetative coma results in a decrease in brain activity and can be fatal as a result of the complications. An improvement in the awake humor becomes increasingly unlikely with the course of the disease.
If the patient is given a nasogastric tube, there are potential risks of injury to the stomach, small intestine, or esophagus. In some cases, the nasogastric tube is placed in the trachea instead of the esophagus, which can cause serious injury and infection. The medicines administered may, in some cases, cause unforeseen side effects.
A doctor is needed as soon as the person concerned is no longer responsive and thus no possibility of communication with him can take place. An ambulance service must be alerted, since intensive medical care becomes necessary. Until the arrival of the doctor, the telephone instructions of the emergency team must be obeyed. Otherwise it threatens the sudden death of the person concerned. If the complaints occur after an accident, a fall or a force, the fastest possible action is necessary. Naturally, in the case of a vegetative coma the person concerned can not undertake any activities himself to seek help. Therefore, present persons are invited to respond immediately.
First aid measures must be used to ensure the survival of the person concerned. Involuntary movements, abnormalities in the rhythm of the heart or twitching of various muscles on the person's body indicate an existing disorder. A lack of breathing, a pale appearance and an empty look are also to be interpreted as warning signs of the organism. If the reaction remains in spite of all efforts, the body does not respond to the natural reflexes also and it comes within a few minutes to sudden changes, the ambulance is to call. In some cases, the development of health problems is creeping. Nevertheless, the help of people present is imperative in a wake coma.
The treatment of the apallic syndrome is based on the developmental stages of neurological early rehabilitation. The focus of therapy is the acute treatment. In this phase, a tracheotomy is usually made and a feeding tube is created through the abdominal wall.
In most cases, a urine drainage is also placed through the abdominal wall. This ensures the vital functions and allows the best possible nursing care for the patient. At this stage, applications of physiotherapists and speech therapists should be carried out. After the acute treatment has been completed, the next phase follows. The therapy is extended by neuropsychological measures and occupational therapy.
Some patients also use music therapy. The goal of these treatments is to improve mental, motor and mental functions. In this phase, which can last from one month to one year, the further course of the patient's state of health decides. If there is a noticeable improvement in mental and physical performance, further action can be taken.
If the person remains unconscious, the so-called "activating treatment" is initiated. The therapy of a wake coma or an apallic syndrome is always under medical supervision, as this is also required and verified by the insurances.
The coma can not be prevented directly. However, any serious damage to the head and brain should be avoided as it could affect brain function. If the coma or the apallische syndrome already exists, the condition of the affected person can be improved a little by targeted therapy measures.
After a wake coma, aftercare plays a very important role. Patients continue to need care after discharge from hospital, depending on the extent of their activity restrictions. This also applies to regained independence. The rehabilitative aftercare takes place on an outpatient basis and extends over a longer period, the duration of which can not always be determined.
Possible aftercare treatments include 24-hour care, non-hospital intensive care, which includes respiratory care, and a residential community cared for on an outpatient basis. In mild cases, assisted living can also be carried out. Some sufferers are even able to work in a special workshop for disabled people.
In contrast, other people in need of long-term care in a day care center, a practice for outpatient neuro-rehabilitation or in a Wachkomahaus. Many patients recover from apallic syndrome in their familiar environment for years to come. Consultations are possible through the care funds.
So they have the task to advise those affected individually in their care within their own home. In many regions there are also special nursing homes available. An important part of the aftercare is the early rehabilitation. It continues acute hospital care and includes therapeutic care, physiotherapy, voice and swallow therapy, occupational therapy and neuropsychological treatments. At the same time, the patient's state of consciousness should be improved.
Naturally, in the case of a vegetative coma the patient can not initiate self-help measures. In this state of health, the person affected acts as if he were awake. In fact, his state of consciousness is minimal or absent. In this situation, he is completely dependent on the support and assistance of the caring medical team and the relatives.
Normally, the person concerned is in a hospital stay. Here the necessary care measures are carried out automatically by medical personnel. Helpful and recommendable is the close cooperation of the relatives with the nurses or helpers of the treating ward. It should be checked at regular intervals on a daily basis if the support points of the patient's body do not develop pressure sores or wounds. Therefore, the person's body is repeatedly to move or to change position. In addition, the continuous creaming of the contact points has proven to be helpful. The patient's environment should be supplied with fresh air several times a day. The oxygen supply supports the organism in the healing process. At the same time, care must be taken that the person affected does not freeze or is exposed to an increased risk of infection.
Although there is insufficient statistical evidence, patients report with hindsight that communication between relatives and patients in the recovery process has a positive impact.