93 Stroke and Coma

• Acute hemorrhagic or ischemic stroke
• Poor functional status (PPS < 50 %) AND
• Poor nutritional status with inability to maintain sufficient fluid and calorie intake as evidenced by one or more of the following:
  • 10% or more weight loss in past 6 months
  • 7.5% or more weight loss in past 3 months
  • Serum albumin < 2.5 gm/dl
  • Current history of pulmonary aspiration without effective response to speech therapy interventions to improve dysphagia and decrease aspiration events

Supporting documentation:

• Coma or persistent vegetative state secondary to stroke, beyond 3 days duration
• Coma or severe obtundation, secondary to post-anoxic stroke accompanied by severe myoclonus, persisting beyond 3 days after the anoxic event
• Chronic phase of hemorrhagic or ischemic stroke evidenced by:
  • Post stroke dementia, FAST stage 7 or beyond
  • Poor functional status with KPS %0% or less
• Coma (any etiology) with any 3 of the following on day three of coma:
  • Abnormal brainstem response
  • Absent verbal response
  • Absent withdrawal response to pain
  • Serum creatinine > 1.5 mg/dl