ABIM Neurocritical case studies
ABIM Neurocritical · Put your knowledge to work in context.
The ABIM Neurocritical Care Certification Examination is a subspecialty board exam for physicians who have completed neurology (or another qualifying) residency plus neurocritical care fellowship training, and who want formal recognition of their ability to manage the full spectrum of catastrophic neurologic illness in an ICU setting. The exam samples broadly across the field: ischemic and hemorrhagic stroke and cerebral venous thrombosis, traumatic brain and spinal cord injury, status epilepticus and ICU EEG, neuromuscular respiratory failure, CNS infections and neuroimmunologic emergencies, coma and brain death determination, general critical care physiology, multimodal neuromonitoring, sedation and toxic-metabolic encephalopathy, plus ethics, communication and systems-based practice. The ABIM Neurocritical case studies are 5 cases and about 3,633 words.
1New focal deficit on day 6 after coiled aneurysmal SAH
A 52-year-old woman is in the NSICU on day 6 after a grade 3 aneurysmal subarachnoid hemorrhage from a left middle cerebral artery aneurysm, secured by endovascular coiling on day 0. She was extubated on day 3 and was oriented until this morning, when she developed a dense right hemiparesis and global aphasia.
672 words, about 3 min2Refractory intracranial hypertension after severe TBI
A 27-year-old man is admitted after a high-speed motorcycle collision with a scene GCS of 6. He is intubated with a right frontal contusion, a 4-mm acute subdural hematoma, and 5 mm of midline shift on the initial CT.
711 words, about 4 min3Refractory status epilepticus with no EEG available overnight
A 59-year-old man with no prior epilepsy is brought in after 25 minutes of generalized convulsive activity witnessed by his wife. He received 10 mg of intramuscular midazolam in the field, then lorazepam 4 mg twice in the emergency department, levetiracetam 60 mg/kg, and fosphenytoin 20 mg of phenytoin equivalents/kg.
712 words, about 4 min4Guillain-Barré syndrome with early respiratory and autonomic failure
A 38-year-old woman presents with 4 days of ascending symmetric limb weakness and areflexia after a diarrheal illness. She can lift her arms against gravity but cannot stand.
730 words, about 4 min5Determination of death by neurologic criteria in a post-arrest patient
A 33-year-old woman remains comatose on day 4 after resuscitation from a witnessed out-of-hospital cardiac arrest with 22 minutes of CPR and an initial rhythm of ventricular fibrillation. She is on propofol 30 mcg/kg/min and fentanyl, mechanically ventilated, with a temperature of 35.6 C and BP of 88/52 mmHg on norepinephrine 0.08 mcg/kg/min.
808 words, about 4 min