Case-Based Modules > Case 21 > Stage 3

The patient arrives to the NCCU. She is kept on propofol and fentanyl gtt that had been started in the ED. Overnight, she has no further ICP elevations, so you’re able to wean off fentanyl the next day, favoring intermittent bolusing for analgesia.

Over the next three days, she has a few intermittent ICP spikes, which respond to sedation, analgesia, and aliquots of hyperosmolar therapy. Repeat neuroimaging demonstrates stability of her known intracranial hemorrhages and cerebral edema. She gets connected to cEEG, which shows a moderate-to-severe encephalopathy, with a diffusely slow and disorganized yet continuous background and preserved state changes. After two days of normal ICPs, her ICP monitor is removed. Unfortunately, she remains unresponsive to voice or noxious stimuli.

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