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hypoxic-ischemic coma prognosis

When you are on you're on your neurology clerkship (or ICU rotations) you will undoubtedly encounter many patients in post-stroke comas. A good physical/neuro exam can help a lot with ultimate prognosis. After 7 days prognosis is almost always apparent. Here is a validated method based on Based on Levy et al JAMA 1985, 253

GOOD = mod disability (independent w/ ADLs) or better
POOR = death, persistent coma until death, or persistent veg state.

  • < 3hrs
    • GOOD (41% good, 41% bad)
      • Eyes: Roving conjugate
      • Motor: Posturing or better
    • POOR (94% bad, 0% good)
      • Eyes: Absent pupillary responses
      • Motor: Posturing or worse
    • 24 hrs.
      • GOOD (63% good, 7% bad)
        • Eyes: Open to noise / spontaneously
        • Motor: Withdraw or better
      • POOR (95% bad, 1% good)
        • Eyes: Not roving conjugate
        • Motor: Still posturing or worse
    • 3 days
      • GOOD (77% good, 8% bad)
        • Eyes: Normal orienting movements
        • Motor: Withdraw or better
      • POOR (93% bad, 0% good)
        • Motor: Still posturing or worse
    • 7 days
      • GOOD (72% good, 6% bad)
        • Obeys commands
      • POOR (100% bad, 0% good)
        • Not obeying commands
        • Eyes: Not roving or orienting, not opening spontaneously

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