IV lorazepam 2mg is given. There's no resolution in his focal status. At this point, your neurology colleague arrives. The patient is still awake and responsive, though perhaps a little sleepier after the lorazepam. She says that she'll give it a shot with IV levetiracetam 3.5g, but that she doesn't want to overdo it and cause somnolence that would necessitate intubation.
The patient is admitted to the NCCU and is connected to cEEG. Over the course of the next few days, a variety of ASMs are utilized. He is also started on dexamethasone to address the vasogenic edema. Ultimately, he does experience some improvement in his symptomatology. You opt to recommend against any neurosurgical intervention, at least at this point. Due to his clinical and electrographic stability, he is ultimately discharged home on two ASMs and with a dexamethasone taper, with close neurology and neurosurgery follow-up arranged.
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