69-year-old female day 19 ICU post SAH secondary to left peri-callosal aneurysm treated with craniotomy, clipping and insertion of EVD and with slow neurological recovery and failed extubation for fluctuating conscious state and retained secretions. Clinical findings included drowsiness but able to obey commands and no focal neurological signs and high urine output. Candidates were directed to examine her and provide a differential diagnosis for her fluctuating neurological state.