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May 10, 2006

BehindTheMedspeak: Never let a person with a head injury fall asleep — myth or fact?


Anahad O'Connor's "Really?" column in the November 15, 2005 New York Times Science section looked into the commonly–held belief that you should never let a person with a head injury fall asleep.

    Here's what he wrote:

    The Facts: Right after a person suffers a potentially serious head injury, those around him often try to force him to stay awake, assuming that being awake will lower the risk of a coma, or worse.

    But experts say that like most old wives' tales that belief is rooted in a misconception.

    Dr. Philip Stieg, the chairman of neurosurgery at NewYork-Presbyterian/Weill Cornell hospital, said the fear stemmed from a phenomenon known as the lucid interval, in which a person seems coherent shortly after being knocked out but later slips into a coma and dies.

    That rarely happens.

    A study this year in the journal Pediatrics looked at 314 children in Pennsylvania who were examined after suffering head injuries that later turned fatal.

    It found that only 2 percent had been declared lucid by doctors before they died.

    Five of those six, the researchers found, were infants whose skills were probably not developed enough to be assessed accurately.


    A good rule, Dr. Stieg said, is that unconsciousness is serious.

    When someone is knocked out and then comes to and seems drowsy, sleep is immaterial, he said.

    Then, only medical attention can make a difference.

    The Bottom Line: Trying to keep a person with a serious head injury awake does not help.



You would think that a neurosurgical anesthesiologist — namely, moi — would know the answer to the question posed by O'Connor.

But I must confess that my instinct with an individual who'd sustained a head injury or anything that altered consciousness would be to try and prevent the person from lapsing into unconsciousness before I could get them to an emergency room.

I recall the old story about Cher walking her then–boyfriend, soon–to–be–husband Gregg Allman around after one of his drug overdoses, trying to keep him from lapsing into a coma.


I'm with Cher.

May 10, 2006 at 02:01 PM | Permalink


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I suppose keeping someone talking to you in the Alarming Situation of your choice does, at least, let you know that they _haven't_ lapsed into a coma. If they seem to be asleep, in contrast, they may be snoozing or may be comatose.

Posted by: Daniel Rutter | May 14, 2006 3:48:54 PM

Hmmmmm just wondering...guess we shouldn't fall asleep at the wheel either? Too many head injuries and not enough sleepers? Ok enough thinking outloud. I do remember a certain person jumping into a swimming pool...acting like a graceful swan diving into the shallow end and WHAM!! That force of hitting your head on the concrete floor while under water and trying to look cool....was immense! And then the little bit of floating there and thinking hey I should stand up since the ground is right there... yet it felt great to float..then having a cousin pull me up to breathe...and come to think of it I never properly thanked him..but who's thinking clearly then?? All I wanted to do was SLEEP!..Peaceful, dreamless sleep! Too avoid the headachey...jelly like feel in my brain...and not to mention the lovely black and blue eyes and forehead....guess grandma shouldn't have let me sleep?? But then she didn't know what else to do either? Yet after almost 30 years I am fine today....well maybe I am...maybe not? lol

Posted by: Rhonda | May 11, 2006 9:08:59 AM

Awww... and we're glad too Flutist!!

Posted by: IB | May 11, 2006 1:16:14 AM

When I was two years old and living in Yokohama, Japan, one day I wandered away from the gaze of my mother (who was busy trying to make herself understood in Japanese to someone on the phone), found a three-quarters full bottle of gin, and drank the WHOLE thing. Like you do when you're two years old. Then there was a great flurry of activity and calling of doctors. While my mother was waiting for my father to get home to take us to the hospital, she was instructed to "Walk her around, walk her around - whatever you do, don't let her fall asleep!" And she did, and I didn't, and things turned out okay, and I'm glad.

Posted by: Flutist | May 10, 2006 2:43:06 PM

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