Stupor and coma in adults - UpToDate

Stupor and coma are clinical states in which patients have impaired responsiveness (or are unresponsive) to external stimulation and are either difficult to arouse or are unarousable. Coma is defined as "unarousable unresponsiveness" [1]. An alert patient has a normal state of arousal. The terms "stupor," "lethargy," and "obtundation" refer to states between alertness and coma. These imprecise descriptors should generally not be used in clinical situations without further qualification. An alteration in arousal represents an acute, life-threatening emergency, requiring prompt intervention for preservation of life and brain function [2,3]. Although discussed separately here, the assessment and management are performed jointly in practice (table 1). ETIOLOGIES AND PATHOPHYSIOLOGY The ascending reticular activating system (ARAS) is a network of neurons originating in the tegmentum of the upper pons and midbrain, believed to be integral to inducing and maintaining alertness. These neurons

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