ABIM Neurocritical study plan

Apply a stepwise eligibility checklist for IV thrombolysis within 4.5 hours of ischemic stroke onset, including blood pressure, anticoagulation, recent surgery, and imaging exclusions.

Compare alteplase and tenecteplase dosing regimens and select the agent and dose for a given patient scenario.

Determine large-vessel-occlusion thrombectomy candidacy across early, late, and wake-up windows using ASPECTS and perfusion-based selection criteria.

Differentiate intracerebral hemorrhage from ischemic stroke on noncontrast CT description and set blood pressure targets for each.

Construct a reversal plan for warfarin-, DOAC-, and heparin-associated intracerebral hemorrhage, and state thresholds for cerebellar surgical decompression.

Calculate and interpret the ICH score to estimate mortality risk and justify goals-of-care discussions.

Grade aneurysmal subarachnoid hemorrhage using Hunt-Hess and World Federation of Neurosurgical Societies scales and set nimodipine and blood pressure targets accordingly.

Detect delayed cerebral ischemia by combining serial exam, transcranial Doppler velocity trends, and CT perfusion findings.

Justify anticoagulation in cerebral venous thrombosis even in the presence of hemorrhagic venous infarction, and identify when endovascular thrombectomy or decompression is indicated.

Identify cerebral venous thrombosis risk factors and explain why isolated headache with normal CT still warrants venography.

Interpret intracranial pressure waveforms and calculate cerebral perfusion pressure at the bedside, stating thresholds that trigger tiered ICP therapy.

Explain brain tissue oxygen tension and pressure-reactivity autoregulation indices and select an appropriate multimodal monitoring bundle for a comatose patient.

Apply the traumatic brain injury management bundle, avoiding hypotension and hypoxia and setting PaCO2, osmotherapy, and seizure prophylaxis durations.

Classify traumatic brain injury severity with the Glasgow Coma Scale and Marshall/Rotterdam CT criteria, and justify medical versus surgical decompression.

Sequence hyperosmolar therapy using mannitol versus hypertonic saline, including dosing, monitoring, and adverse-effect checks.

Manage acute spinal cord injury with mean arterial pressure augmentation, timing of surgery, and a reasoned position on methylprednisolone.

Differentiate neurogenic shock from spinal shock and select vasopressor and chronotropic support with appropriate monitoring.

Decide timing of venous thromboembolism prophylaxis in traumatic intracranial hemorrhage and spinal cord injury.

Sequence benzodiazepine and antiseizure medication dosing by weight through the stages of status epilepticus, including refractory status.

Apply Salzburg electrographic criteria to identify nonconvulsive status epilepticus using written EEG descriptions.

Interpret background EEG patterns, including periodic discharges, burst suppression, and triphasic waves, and distinguish ictal from encephalopathic patterns.

Titrate continuous midazolam, propofol, or ketamine infusions for refractory status epilepticus while monitoring for hypotension, propofol infusion syndrome, and sedation-related exam confounders.

Select the antiseizure medication whose pharmacokinetics best fits renal failure, hepatic failure, pregnancy, or drug interaction scenarios.

Determine when to initiate continuous EEG and how long to monitor before excluding nonconvulsive seizures in a comatose patient.

Set mechanical ventilation targets for neurocritical care patients, including PaCO2 goals in traumatic brain injury and the role of hyperventilation as a temporary bridge.

Differentiate cerebral salt wasting from syndrome of inappropriate antidiuretic hormone secretion and select fluid and sodium correction strategies.

Manage sepsis and septic shock in a patient with acute brain injury, weighing fluid resuscitation against osmotic and hemodynamic goals.

Assess extubation readiness and aspiration risk in a patient with a depressed sensorium, and decide on tracheostomy timing.

Adjust antiseizure medication and antibiotic dosing for renal replacement therapy and for augmented renal clearance.

Apply nutrition support timing and electrolyte repletion targets in critically ill neurologic patients.

Match sedation and analgesia agents to renal, hepatic, and hemodynamic limitations, and state dose adjustments for each.

Predict the neuroexcitatory and electroencephalographic effects of common ICU sedatives and identify drug-induced causes of a falsely abnormal neurologic exam.

Differentiate toxic-metabolic encephalopathy patterns, including uremic, hepatic, hyperammonemic, and osmotic demyelination syndromes, from structural causes.

Select the highest-yield imaging modality and contrast strategy for an acutely encephalopathic patient with renal impairment.

Design a daily sedation interruption and delirium monitoring plan that preserves reliable serial neurologic examinations.

Decide between intravenous immunoglobulin and plasma exchange for Guillain-Barre syndrome and myasthenic crisis, and state timing and contraindications.

Monitor respiratory mechanics in neuromuscular weakness using vital capacity, negative inspiratory force, and bulbar assessment, and state intubation thresholds.

Manage dysautonomia in Guillain-Barre syndrome and identify drugs that precipitate a myasthenic crisis.

Differentiate critical illness myopathy from critical illness polyneuropathy and select an evaluation plan including electromyography and muscle biopsy indications.

Select empiric therapy and dexamethasone timing for bacterial meningitis and justify dexamethasone avoidance in nonpneumococcal scenarios.

Apply first-line treatment and escalation for herpes simplex encephalitis, anti-NMDA receptor encephalitis, and other neuroimmunologic conditions requiring ICU care.

Perform a structured coma examination that distinguishes metabolic, structural, locked-in, and psychogenic unresponsiveness.

Differentiate coma, vegetative state, minimally conscious state, and brain death by examining arousal, awareness, and brainstem function.

Verify prerequisites and perform the apnea test for determination of death by neurologic criteria, and identify common confounders that invalidate the exam.

Justify decisions about tracheostomy, gastrostomy, and withdrawal of life-sustaining treatment using a clear ethical framework and prognostic evidence.

Conduct a family meeting in which you elicit goals, deliver prognostic uncertainty honestly, and document a shared decision.

Describe systems-based resources for prognostication, organ donation, and palliative care consultation in the neuro-ICU.