Accelerated emergence from a nontraumatic minimally conscious state with levodopa/carbidopa

A 62-year-old woman was admitted to our hospital in coma following the nontraumatic rupture of a left posterior inferior cerebellar artery aneurysm with subsequent intraventricular hemorrhage and acute hydrocephalus, affecting mainly the fourth ventricle with substantial adjacent edema (figure 1). Her Glasgow Coma Scale score was 3/15 and physical examination showed left hemiparesis, absent corneal and oculovestibular reflexes. Dexamethasone (4 mg q6h) and mannitol (1 g/kg initially, then 0.5 mg/kg q6h) were started, and a frontal bilateral trephination with external ventricular drainage was performed. Initial sedation was waned and discontinued 7 days later. The right and left ventricular drains were removed 9 and 15 days after placement, respectively, when a head CT scan showed reduction of the intraventricular hemorrhage and hydrocephalus (figure 2). Transcranial Doppler on days 2 and 8 showed no vasospasm. Serial EEGs on days 14, 21, and 28 showed no ictal activity. The aneurysm was successfully embolized 34 days after admission.