The dead and dying tissue is then surgicaly removed. In other cases the skull is sawed off and placed in cold storage to better accommodate the swollen brain. There are two principle types of coma associated with head and spinal trauma. The first type results from cerebral contusion, lacerations, and edema. Often, they are accompanied by severe head injuries, and by fractures of the skull.
Respiration is labored due to pulmonary congestion, or chest wounds.
The second type of coma is caused by damage to the brainstem. Signs include coma. Such cases almost always imply severe brain damage and carry a poor prognosis. Acute subdural or intracerebral hematomas are common in severe head injury and, together with severe brain edema, are present in most fatal cases. Coma has two principle stages and many intermediary stages.