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Published online by Cambridge University Press: 30 August 2019
A 51-year-old male is admitted via the emergency department after suffering a cardiac arrest and a resulting head injury when he collapsed. Despite arriving in hospital with a stable circulation, he is agitated and very confused. His ECG shows changes consistent with an anterolateral infarction and a CT head does not show any abnormality. He is anaesthetized, undergoes an angioplasty and is admitted to critical care. After failed sedation holds the next day, a CT head is repeated and an EEG is also obtained. The imaging demonstrates cerebral oedema and the EEG shows seizure activity. These are treated medically for a few days and the patient’s consciousness improves. However, during this time, he develops ventilator-associated pneumonia, requiring ventilation for a further week. After this, despite improved neurology, there is difficulty in weaning the patient off the ventilator. He is investigated for critical illness weakness and nerve conduction studies. Electromyography confirms critical illness myopathy. With supportive management and appropriate rehabilitation, he eventually recovers.
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