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What Neurologists Know About Outcome in Post-Resuscitation Coma and What Other Physicians Want to Know 

What Neurologists Know About Outcome in Post-Resuscitation Coma and What Other Physicians Want to Know
Chapter:
What Neurologists Know About Outcome in Post-Resuscitation Coma and What Other Physicians Want to Know
Source:
Neurocritical Care (2 ed.)
Author(s):

Eelco F. M. Wijdicks

, Alejandro A. Rabinstein

, Sara E. Hocker

, and Jennifer E. Fugate

DOI:
10.1093/med/9780190602659.003.0041

Important principles in the prognostication of any patient with acute brain injury include assessing the severity of brain injury, understanding the mechanism of injury, allowing appropriate time for assessment, and excluding confounders. Targeted temperature management is used to manage comatose patients after cardiopulmonary resuscitation, and it has introduced new confounders with the neurological examination. Neurological prognostication, discussed in this chapter, should thus be neurocritical care terrain. Poor prognosis can be expected in patients with absence of pupillary light responses, corneal reflexes, and an extensor or absent motor response, or myoclonus status epilepticus. Sedative medications can abolish corneal reflexes and motor responses to noxious stimulation. Their confounding effects need careful judgment. Bilateral absence of cortical (N20) responses is a very reliable indicator of poor prognosis, but only discriminates the worst cases of anoxic brain injury. Documented discrete electrographic seizures may need treatment, but the value of aggressive antiepileptic treatment for generalized epileptiform discharges or burst suppression in anoxic-ischemic brain injury is uncertain.

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