CASE PRESENTATION: A 37-year-old man was brought to our Emergency Department (ED) after being found unresponsive. EMS noted fixed-dilated pupils and SpO2 40%. He received naloxone without response and was intubated in the field. Neurologic examination in the ED showed 5mm non-reactive pupils. Corneal, Doll’s eye and gag reflexes were all absent. He exhibited decerebrate posturing with stimulation and intermittent rhythmic flexor motions in the upper extremities coupled with left gaze deviation. Plantar reflexes were downward. He was loaded with levetiracetam and was transferred to the medical intensive care unit. Laboratory tests were unremarkable including acetaminophen, salicylate, and alcohol levels. Urine drug screen was positive for cannabinoids. CT brain revealed global cerebral edema with grey-white matter indifferentiation (image1) consistent with anoxic brain injury. He was treated with hypertonic saline (3%). Two days later, he awakened, was interactive but combative. Two hours after his extubation, he was ambulatory and admitted to marijuana and K2 use.