A 29-year-old male admitted with severe traumatic brain injury following a road traffic accident was sedated and ventilated uneventfully for 72 h. On the fourth posttrauma day, after stopping sedation to assess readiness for extubation, he developed sudden onset desaturation; arterial blood gas showed severe diffusion defect with very low PaO 2 /FiO 2 ratio following an episode of generalized tonic-clonic seizure. The differential diagnoses and further management are discussed.
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