Your neurology colleague is happy to assume further care of the patient, so you go back to your other ten acute ED consults. You have to admit a few of them to the NCCU, but one of them also needs to be crashed to the OR for an emergent DHC. Busy night.
On day 5 of admission, you're still on call. The MICU resident pages you to urgently evaluate the patient. They tell you that the patient had modestly improved and had regained their pupillary reactivity and mental status, though she again has fixed and dilated pupils.
Well this is strange. Having episodic profound neurologic dysfunction in the form of obtundation and pupillary dilation and non-reactivity without any disease-specific treatment in between is highly unusual.
Of course, you go to examine the patient. You already know you're going to ask them to get a STAT non-contrast head CT. The patient's examination in the same as it was the first day you saw her.
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