ABIM Neurocritical study guide
ABIM Neurocritical · Work through your exam, one topic at a time.
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 study guide has 10 sections and about 2,668 words.
01Cerebrovascular Disease in the Critically Ill
The clock starts at last known well, not at symptom discovery or arrival. IV alteplase is offered within 4.5 hours (and in selected wake-up strokes with DWI-FLAIR mismatch); endovascular thrombectomy for large vessel occlusion within 6 hours, and up to 24 hours with favorable perfusion or DAWN/DEFUSE-3 imaging profiles.
297 words, about 1 min02Neurotrauma: Traumatic Brain Injury and Spinal Cord Injury
Separate primary from secondary injury and prevent the second hit. Avoid hypoxia (SpO2 <90%) and hypotension (SBP <100 mmHg, or <110 in patients 15-49 and over 70).
255 words, about 1 min03Seizures, Status Epilepticus, and ICU EEG
Convulsive status epilepticus begins at 5 minutes of continuous seizure activity; focal status with impaired awareness at 10 minutes. Treat with a benzodiazepine first (IM midazolam if no IV access), then a second-line agent: levetiracetam 60 mg/kg, fosphenytoin 20 phenytoin equivalents/kg, or valproate 40 mg/kg.
250 words, about 1 min04Neuromuscular Disorders in Critical Illness
Guillain-Barre presents with progressive symmetric weakness and areflexia, peaking within four weeks. Monitor vital capacity, negative inspiratory force, and bulbar function; admit to ICU for a vital capacity below 20 mL/kg, MIP less negative than -30 cmH2O, or swallowing failure.
273 words, about 1 min05Neuroinfectious and Neuroimmunologic Disorders
Do not delay antibiotics for imaging or lumbar puncture. Empiric therapy is vancomycin plus ceftriaxone 2 g every 12 hours, adding ampicillin when Listeria is a concern (age over 50, immunocompromise, alcohol use).
283 words, about 1 min06Disorders of Consciousness, Coma, and Determination of Death by Neurologic Criteria
Distinguish coma, vegetative state (unresponsive wakefulness), minimally conscious state, locked-in syndrome, catatonia, and pharmacologic paralysis. The locked-in patient is awake with vertical eye movement despite quadriplegia.
286 words, about 1 min07General Critical Care Applied to Neurologic Patients
Use lung-protective ventilation with tidal volumes around 6 mL/kg predicted body weight and plateau pressures at or below 30 cmH2O, but remember that permissive hypercapnia raises intracranial pressure. In a patient with a brain injury, target normocapnia (PaCO2 35-40 mmHg) while accepting the usual ARDS strategy only when ICP is not a concern.
278 words, about 1 min08Neuroimaging and Multimodal Neuromonitoring
Noncontrast CT identifies hemorrhage, midline shift, and the hyperdense vessel sign; the ASPECTS score quantifies early ischemic change. CT angiography demonstrates large vessel occlusion and aneurysm; CT perfusion distinguishes core from penumbra.
272 words, about 1 min09Neuropharmacology, Sedation, Analgesia, and Toxic-Metabolic Encephalopathy
Target a defined sedation scale rather than a subjective impression. Propofol is short acting but causes propofol infusion syndrome with high doses (above roughly 4-5 mg/kg/hour), prolonged infusions, acidosis, rhabdomyolysis, and bradycardia.
227 words, about 1 min10Procedures, Ethics, Communication, Palliative Care, and Systems-Based Practice
External ventricular drain placement risks hemorrhage, malposition, and infection; use antibiotic-impregnated catheters, avoid prolonged drainage, and never flush the drain. Lumbar puncture is deferred for focal deficits, seizures, papilledema, coagulopathy, or cardiopulmonary instability, and anticoagulation must be held appropriately.
247 words, about 1 min