22 DISCOVERMAGAZINE.COMSOMKKU/SHUTTERSTOCKThe Big
Sleep
A healthy 29-year-old collapses
and remains in a coma despite
months of treatment.
BY ELIEZER J. STERNBERG→
Antonia was missing. She had
failed to pick up her 14-month-
old daughter, Tia, at day care, and
her sister, Jaclyn, couldn’t reach her
by phone.
Jaclyn headed to Antonia’s house to
ind out what the problem was. When
she arrived, she noticed the front
door was unlocked — a bad sign. She
searched the rooms, calling out her
sister’s name, until she heard running
water coming from the kitchen.
Jaclyn found the 29-year-old lying
on her back unconscious, brown
foam on her lips. Her eyes were open,
staring in the direction of her car keys
on the tile oor. The faucet was on.A CLUE EMERGES
During the ambulance ride, responders
intubated Antonia to keep oxygen
owing into her lungs. They also
performed a series of tests: an
electrocardiogram, which records
the heart’s electrical activity, and
measurements of her pulse and blood
pressure. Everything was normal.
The responders then checked her
blood sugar to see if she was in a
diabetic coma, a common cause of
sudden unconsciousness. They also
gave her naloxone, which reverses an
opioid overdose, typical protocol when
someone is found unconscious.
When she arrived in the emergency
room, still unconscious, Antonia
underwent more tests, including for
drugs in her system. No red ags
appeared. A CT scan of her brainfound no abnormalities.
Why would a generally healthy
person suddenly collapse and become
comatose? I talked to Jaclyn, in search
of clues.
“She’s a really responsible person,”
Jaclyn said. “And she’s a really good
mom, I’m telling you. Even after she
passed out, she was reaching for her
car keys to, you know, pick up her
daughter.”
“What do you mean?” I asked. “She
was moving?”
“No, not moving. Her eyes were
locked on the keys, staring directly
at them.”
Noticing my expression change, she
paused. “Does that mean something?”
“Which way did you think her eyes
were looking?”
“Left.”I went back to Antonia’s bedside in
the ER and gently retracted her eyelids.
Her pupils were midline — looking
straight ahead.
We admitted Antonia to the hospital’s
neurology intensive care unit.SEIZURE SITUATION
I suspected Antonia had had a seizure,
caused by abnormal electrical iring
in the brain. People often think of
seizures as full-body convulsions,
known as generalized seizures, which
can affect the entire brain. But
people can also have focal seizures
that impact only part of the brain.
These can involve subtle symptoms:
slight twitching of the face, a tingling
sensation, a temporary speech problem
— or involuntary eye movement.
A seizure in the frontal lobe can
cause the eyes to deviate to one
side, then return to midline when
the seizure ends. I suspected that’s
what had happened to Antonia.
But usually within hours after a
seizure, patients wake up; the fact
that Antonia’s eyes had returned to
midline suggested her seizure was
over. She should be awake.
That presented two possibilities:
Either her seizure had ended very
recently and she hadn’t yet recovered,
or she was having a so-calledWhen she arrived in
the emergency room,
still unconscious,
Antonia underwent
more tests, including
for drugs in her system.
No red lags appeared.
Vital
Signs