33-year-old female with a history of significant alcohol use, day 3 post coiling of PICA aneurysm and who had been re-intubated for confusion. CT scan the previous day had shown a left cerebellar infarct. Clinical findings included ongoing blood-stained CSF drainage, hypertonic saline infusion in progress, no obvious neurological defect, intact airway reflexes and a clear chest. Candidates were directed to examine her with a view to determining her suitability for extubation and to make a management plan.