Emergence From Minimally Conscious State Following Addition of Zolpidem to Amantadine Therapy in a Patient With Preserved Cortical Metabolism After Subarachnoid Hemorrhage: A Case Report.

We report the case of an 80-year-old female patient with subarachnoid hemorrhage who demonstrated marked improvement in the Coma Recovery Scale-Revised (CRS-R) score following the addition of zolpidem to amantadine therapy. Brain positron emission tomography-computed tomography demonstrated diffuse cerebral hypometabolism with relatively preserved fronto-parietal cortical uptake, suggesting preserved cortical metabolic activity. After initiating zolpidem 10 mg and escalating amantadine to 200 mg/day, the patient's CRS-R score increased from 12 to 19 within three days, corresponding to emergence from a minimally conscious state. This case suggests that preserved cortical metabolic activity may be associated with the additive or synergistic effects of pharmacological arousal therapy in disorders of consciousness in non-Traumatic Brain Injury patients.