75y m with history of road traffic accident with left side frontal contusion with midline shift of 3 mm was admitted in icu
His GCS on admission was E2V2M5 and patient was extubated after two days of close monitoring as GCS improved to 12/15.
Today morning patient suddenly developed breathlessness,blood pressure started to fall and saturation too fell so he was intubated again
Now his GCS is E1VtM1
On check CT the midline shift is now 2 mm and echo is normal
What can be the cause of this deterioration