department, he was minimally responsive. He was intubated immediately, and large-bore peripheral intra- venous catheters were inserted. Computed tomography of the head revealed massive, nonsurvivable intraparenchy- mal hemorrhage with midline shift, effacement of the sulci, and pronounced distortion of the ventricular sys- tem. AF was not a candidate for surgery.
AF was admitted to the ICU for medical management, including osmotic diuresis with mannitol, elevation of the head of the bed to minimize probable abnormal increases in ICP, ventilator management, and blood pres- sure control. A neurological assessment at the time of admission revealed pupil dilatation with sluggish reactions and weak cough, gag, and corneal reflexes. On ICU day 2, he experienced periods of severe hypertension and tachycardia when he lost all brain stem reflexes and had clinically evident loss of brain and brain stem functions.