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Mr. Jones is a 65-year-old man with a past medical history of coronary artery disease who is admitted after an unwitnessed pulseless electrical activity arrest at home. He achieved return of spontaneous circulation (ROSC) in the emergency department but now remains unconscious. Upon transfer to the intensive care unit, he is intubated, sedated, and undergoing targeted temperature management (TTM) targeting 36˚C. Over the next few days, sedation is discontinued as he completes TTM and controlled rewarming. Twenty-four hours after restoration of normothermia, he remains unconscious. His clinical examination is unchanged from prior: preserved pupillary and corneal reflexes bilaterally and a reflexive flexor response to painful stimuli. Continuous electroencephalography (EEG) reveals no seizures, preserved continuity, and unclear background reactivity to stimulation (Figure 10.1). Brain magnetic resonance imaging (MRI), obtained on day 4, is notable for restricted diffusion in the bilateral primary sensory cortices (Figure 10.2). Mr. Jones’s family requests a meeting to discuss his chances of achieving a “meaningful recovery.”
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