An unusual clinical course is no complications after extirpation of a tumor, but then no awakening of the patient. Evaluation of the patient, interpretation of neuroimaging findings, and potential causes are discussed in this chapter. Neurological worsening after craniotomy for tumor surgery can be due to cerebral vasospasm. The cerebral vasospasm can be diffuse and not only in the surgical field and may only be documented by cerebral angiogram. Worsening can also occur because of hemorrhage in the surgical bed, remote hemorrhage, cerebral edema, or ischemic stroke from sacrifice of a large vein or artery. Postoperative seizures may present with focal seizures, which may evolve into partial or generalized status epilepticus.