Dear Doctor, I am seeking help from you, since my sister is in coma for last 27 days and being treated at Critical Care Unit of Tata Main Hospital, Jamshedpur. I am enclosing her brief case summary given by the doctor on our personal request. I sincerely request you to have a look at the case summary and suggest. I am also enclosing the list of medicines and blood report for your information. Case summary Mrs Sharmila Sen 37/f was to undergo planned hysterectomy on 28/12/11.she is a known asthmatic on MDI(metered dose inhalers).as her hemoglobin was low preop packed cell transfusion was decided(Hb was 7gm/dl) by her treating doctor.She developed sudden onset uneasyness followe by shortness of breath after getting about 70 ml of blood and then had a cardiac arrest on 27/12/11 evening.she was attended by the anaesthesist who intubated and cardiac resuscitation was done .she was then shifted to CCU where she had refractory status epilepticus which was managed with inj midazolam ,inj leveteracetam etc. she was put on ventillatory support soon after shifting to ccu. tracheostomy was done on 05/01/2012. she had once developed pulmonary oedema which was taken care of. at present she is on ventillatory support and is comatosed.she is noticed to have myoclonic jerks off/on.signs of decorticate rigidity were also noticed . she had developed fever last week which has settled down. at present on anti-epileptics,suppurtive care.she is off ionotropes . clinically looks post cardiac arrest hypoxic brain damage. Additional information # She is an old patient of asthma and used to take Tab - Derifyline (Theophyline) and inhaler Asthalin regularly, & Tab - Prednisolone occasionally. # She had brain hypoxia lasted for approx 6 - 7 minutes. # She is presently maintaining Glasgow coma scale at 4. # Her present hemoglobin level is 9.1 after one pack of ( Leuco reduce ) Blood (Hb was 6.6 before transfusion). Examination : MRI BRAIN WITH MR ANGIO WITH MR VENO (NCMR)Multiplanar multiecho MR of the brain has been performed. The study shows normal frontal, temporal parietal and occipital lobes of both cerebral hemispheres. Intervening inter-hemispheric and sylvian fissures and cerebral sulci are also normal. Basal ganglia are normal. No ventricular dilatation seen. Basal cisterns brain stem and cerebellum are normal with normal cerebellar peduncles. Vessels visualised at base of brain reveal normal flow void on all sequences. No abnormality of cranial nerves that could be defined and seen. Cranial vault shows normal outer and inner tables and diploic space. IMPRESSION : NORMAL MRI OF BRAINMRA – 3T TOF MRA shows normal flow signal in the “Circle of Wills”. No morphological abnormality is seen. No steno sing lesion is seen. Regards, Samrat