Clinical Prognosis

In cases of cerebral herniation complicated by ischemia, patients may suffer permanent neurologic sequelae if coma duration is 6 hr or longer. In addition, individuals with absent pupillary light reflexes never appear to regain independent daily function, but the early onset of incomprehensible speech, orienting spontaneous eye movements, or the ability to follow commands are considered indicative of a good outcome. Recent studies confirm the prognostic value of the neurologic examination that focuses on pupillary and motor function.

Measurement of intracranial pressure has also been linked with prognosis. Most patients with a maximum intracranial pressure increase of less than 30 mmHg experience good recovery. In contrast, a pressure increase more than 30 mmHg, and in some cases an intracranial pressure increase more than 20 mmHg, represents a great risk for the brain. Others have noted that in a limited number of cases aggressive treatment based on intracranial pressure monitoring can reduce mortality when applied to patients in coma secondary to cerebral infarction.

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