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

A physician may determine that a patient has a life expectancy of six months or less even if the above findings are not present. Co-morbidities also support eligibility for hospice care.