ABPN Neurocritical Care case studies
ABPN Neurocritical Care · Put your knowledge to work in context.
The ABPN Neurocritical Care examination is a subspecialty certification exam for physicians who have completed neurology training and advanced fellowship training in neurocritical care, and who manage critically ill patients with primary neurologic disease as well as neurologic complications of systemic illness. The exam samples broadly across the field: neurophysiology and intracranial dynamics, ischemic and hemorrhagic stroke including neurointerventional care, traumatic brain and spinal cord injury, status epilepticus and continuous EEG, neuromuscular and neuroinfectious emergencies, postoperative neurosurgical care, multisystem organ support, neuroimaging and neuromonitoring including brain death determination, ethics and prognostication, and neuropharmacology and toxicology. The ABPN Neurocritical Care case studies are 5 cases and about 3,104 words.
1Refractory Status Epilepticus with Burst Suppression and Hypotension
A 47-year-old woman with a prior right middle cerebral artery stroke presents with 90 minutes of generalized convulsive activity that stopped after 8 mg IV loracaine-equivalent benzodiazepine given prehospital and 4 mg IV lorazepam in the ED. She is now unresponsive with subtle right facial and arm twitching.
616 words, about 3 min2Post-Craniotomy Deterioration: Blood Pressure Target Conflict
A 58-year-old man undergoes emergency decompressive hemicraniectomy and hematoma evacuation for a spontaneous right basal ganglia hemorrhage (initial volume 55 mL, GCS 7). Postoperative day 1 in the NSICU: intubated/sedated, ICP monitor (parenchymal) reads 18–22 mmHg, CPP 60–65 mmHg, MAP 82 mmHg on no pressors, HR 88, temp 37.8 C.
630 words, about 3 min3Post-Cardiac-Arrest Targeted Temperature Management and Brain Death Prognostication
A 62-year-old woman with hypertension and type 2 diabetes has a witnessed out-of-hospital cardiac arrest (ventricular fibrillation), bystander CPR, ROSC after 22 minutes. She is comatose, intubated, on 0.1 mcg/kg/min norepinephrine, target temperature management at 33 C initiated.
677 words, about 3 min4Myasthenic Crisis versus Cholinergic Crisis versus Sepsis in a Ventilated Patient
A 34-year-old woman with known acetylcholine receptor antibody-positive myasthenia gravis on pyridostigmine 60 mg q6h and prednisone 10 mg daily presents with 2 days of worsening dysphagia and breathlessness. On arrival: BP 138/84, HR 104, RR 28, SpO2 92% on 2 L, temp 38.6 C, bilateral ptosis, nasal speech, weak cough, and paradoxical abdominal breathing.
550 words, about 3 min5Traumatic Brain Injury with Conflicting Coagulopathy and Antithrombotic Reversal
A 71-year-old man on apixaban 5 mg BID for atrial fibrillation and aspirin 81 mg daily falls down stairs and presents with a GCS of 13 (E3 V4 M6) that drops to 9 at 45 minutes. CT shows a 12 mm right frontal acute subdural hematoma with 6 mm midline shift, a left frontal contusion, and a small traumatic subarachnoid hemorrhage.
631 words, about 3 min