Not sure on this one but I am confident about it:
On page 20 of the rules about Brain Damage,
The Runner randomly trashes one card from his grip for each point of brain damage done to him, and his maximum hand size is permanently reduced by one card. The Runner takes a brain damage token to track this .
So if the particular piece of ice had a subroutine, "Do 4 brain damage," it would mean that the runner would randomly trash 4 cards and then take one brain damage?