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You are treating an elderly male patient who fell on the sidewalk outside his home, striking his head hard. It was a witnessed fall by family members who called EMS immediately. Although he was initially responsive, by the time EMS arrives the patient responds to painful stimuli with muscular extension, pupils are becoming unequal but are still sluggish to respond, and he displays an elevated blood pressure, wide pulse pressure, and bradycardia. Given these findings, what level of brainstem involvement is suspected?

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