A Woman Found Unresponsive

She was intubated for airway protection in the emergency department. She remained comatose without sedative medications. Brainstem reflexes were preserved, and she had intermittent leg myoclonus. Evaluation showed acute kidney injury, a normal serum osmolal gap, negative standard toxicology screen, and diffuse cortical dysfunction on EEG. A brain MRI (see Figure 1) showed patchy cortical diffusion restriction, compatible with hypoxic–ischemic injury or toxic–metabolic encephalopathy. The patient began hemodialysis, and she slowly made a full recovery. A baclofen level drawn at presentation was 1.2 μg/ml (reference range, 0.08–0.40 μg/ml).