Stroke and Coma

The patient has findings of:

  • Acute hemorrhagic or ischemic stroke evidenced by:
    • Coma or persistent vegetative state secondary to stroke, beyond 3 days duration or
    • Coma or severe obtundation, secondary to post anoxic stroke, accompanied by severe myoclonus, persisting beyond 3 days after the anoxic event or
    • Dysphagia, which prevents sufficient intake of food and fluids to sustain life in a patient who does not receive artificial nutrition and hydration
    • Chronic phase of hemorrhagic or ischemic stroke evidenced by: Post-stroke dementia, stage 7 or beyond according to the Functional Assessment Scale (see Dementia)
  • Poor functional status with Karnofsky Performance Status 50% or less or
  • Poor nutritional status, whether on artificial nutrition or not, with inability to maintain sufficient fluid and calorie intake with > 10% weight loss during the previous six months or serum albumin < 2.5 gm/dL or
  • Coma (any etiology) with any three of the following on day three of coma:
    • Abnormal brain stem response
    • Absent verbal response
    • Absent withdrawal response to pain
    • Serum creatinine > 1.5 mg/dL
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