60-year-old male, ICU day 9, presented following a seizure at work secondary to a sub arachnoid haemorrhage, with an initial GCS of 6. The aneurysm was clipped on day 1 and he subsequently failed extubation. Clinical findings included hypertension, the presence of an EVD wound scar, GCS E1 M2-3 VT, hypotonia, no response to facial pain and upgoing plantars bilaterally.
Candidates were directed to assess and explain his neurological status.
Discussion points included causes for deterioration after sub-arachnoid haemorrhage, investigation and management of vasospasm, and the causes of fever.