Cerebrovascular Disease:   Stroke, Coma,

In the Acute phase of hemorrhagic or Ischemic stroke:

1 of the following must fee present:

• Dysphagia, which prevents sufficient intake of foods
  and fluids, in a patient who does not receive artificial
  nutrition. Nutritional decline despite artificial
  nutrition and adjustments in formula.
• Post-anoxic stroke- coma or severe obtunded with
  severe myoclonus
• Coma or persistent vegetative state

In the Chronic phase of hemorrhagic or Ischemic stroke:

1 of the following must be present:

• Post-stroke dementia:

o    Unable to ambulate without assistance;

o    Unable to dress or bathe without assistance;

o    Urinary and fees! incontinence, constant or

intermittent; o    Ability to speak Is limited to < 6

words or speech is meaningless and inappropriate

• Poor functional status with Karnofsky score of 40% or less
• Poor nutritional status, artificial or not, with
  progressive weight loss over the past 6 months or
  serum albumin <2.5gm/d!.

Coma {any etiology) – Comatose patients with any 3 of the following on day three of the coma:

• Abnormal brainstem response;
• Absent verbal response;
• Absent withdrawal response to pain;
• Serum creatinine > 1.5mg/dl
  
• Supporting documentation includes:

• Aspiration pneumonia
• UTI or Sepsis
• Stage 3 or 4 decubitus ulcers
• Fever recurrent despite treatment with antibiotics
• Abnormal findings from CT or MRI scans, if available