Patient 4, a 63-year-old man with previous myocardial infarction, hypertension, and diabetes mellitus, suffered from a CT-proven infarct of the complete right MCA territory. Decompressive hemicraniectomy was performed 37 hours after onset of the left-sided hemiparesis. On day 4, MRI additionally revealed infarcts in the vascular territories of the left MCA and right posterior inferior cerebellar artery as well as both cerebellar hemispheres. No SDs were recorded before the terminal one. A family discussion was held and a DNR-CC order was activated followed by terminal extubation on day 5. Figure B shows the nonspreading depression of activity during the falling phase of ptiO2. A very slow, homogeneous DC positivity started simultaneously with the drop in ptiO2. Superimposed on this DC positivity, the terminal SD then started at electrode 3.
Patient 5 was a 47-year-old male occupant of a car struck by a train with reported field Glasgow Coma Scale (GCS) = 3. The patient was intubated for airway protection and arrived at the trauma center with presentation GCS = 3T. Bilateral chest tubes were placed for traumatic pneumothoraces. Once stabilized, the patient had a postresuscitation GCS = 1T3. CT of the head demonstrated skull vault fractures, diffuse traumatic SAH, subdural hematoma, and diffuse petechial shear injuries. He was admitted to neurocritical care, and an ICP monitor was placed with elevated ICP noted. A family discussion was held on day 2, a DNR-CC order was activated, and the patient was terminally extubated. Similar to Patients 2 and 4, nonspreading depression occurred while ptiO2 showed the final drop. The terminal SD started 73 seconds after nonspreading depression had rendered the ECoG isoelectric (Fig A, B).