STROKE IN THE MEDICAL INTENSIVE-CARE UNIT

Objective: To analyze the occurrence and outcome of new-onset stroke i n critically ill patients admitted to a medical intensive-care unit. M aterial and Methods: We reviewed the medical records of patients admit ted to the medical intensive-care units of two hospitals between 1985 and 1995, In addition, computed tomographic scans or scan reports mere assessed, Results: We identified 19 patients with a critical medical illness and a new-onset stroke, Of this study group, ischemic stroke d eveloped in 10 patients, 8 of whom were found to have bihemispheric in farction, A single territory infarct (the middle cerebral artery terri tory) was noted in two patients. The presumed mechanisms for ischemic stroke were disseminated intravascular coagulation (N = 6), cholestero l embolization (N = 1), discontinuation of warfarin therapy before an invasive procedure (N = 1), septic emboli (N = 1), and cardioversion ( N = 1), In nine patients, an intracranial hemorrhage developed. Seven patients had a single lobar hematoma, whereas multiple intracerebral h ematomas were found in two patients. Disseminated intravascular coagul ation and rupture of a mycotic aneurysm in proven infective endocardit is were the most common mechanisms for hemorrhagic stroke. In all pati ents with an ischemic stroke, sudden hemiparesis rapidly progressed to coma, In patients with an intracranial hematoma and sudden onset of c oma, unilateral fixed pupil was the most common initial manifestation. Of the 19 patients, 17 died and 2 remained severely disabled. Conclus ion: Coma is a common initial manifestation of stroke in patients with a critical medical illness, and disseminated intravascular coagulatio n has a major etiologic role. New-onset stroke in the setting of criti cal medical illness generally is a complication in a terminally ill pa tient.