A 1997 report from the Journal of Neurology, Neurosurgery and Psychiatry notes how discoloured fingernails may be a secondary effect of coma owing to the side-effects of a common medical assessment for consciousness.
The test is nothing more high-tech than giving the finger a hard prod with a pencil to see if there is any reaction to pain, which is a common test on unconscious patients.
In fact, it forms part of the universally used Glasgow Coma Scale. You’ll often hear doctors saying “the patient was admitted with a GCS of…” followed by a number up to 15 which rates how conscious and alert the patient is, depending on their reaction to various prods, pokes and verbal requests.
The brief article reported an unintended side-effect of repeated Glasgow Coma Scale assessments after a patient woke up from coma to find her nails all black and blue.
A 30 year old woman was admitted to hospital with a rapidly progressive decline in level of consciousness and seizures. Neuroimaging studies disclosed thrombus in the superior sagittal sinus, bilateral cerebral venous infarctions, and oedema. She was treated with intravenous heparin and propofol for control of agitation and increased intracranial pressure. She made an excellent recovery.
Three weeks after admission she alerted us to a painless brownish discolouration of many of her fingernails. Bilateral subungual haematomas in different stages of resolution were noted. These lesions had been created by frequent nail bed compression with a pencil to monitor motor response, a common practice of applying noxious pain stimuli in comatose patients admitted to neurological intensive care units.
Obviously, if you’re a Goth, Glasgow Coma Scale evaluations are likely to have much less of an impact on your post-coma nail care routine.
Link to brief JNNP piece on ‘Coma Nails’.
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