This issue marks the end of my first term and sixth year as editor-in-chief of Continuum and, I am pleased to announce, the start of my final 4-year term in this role. I am delighted that this juncture is marked by this well-organized and remarkably thorough issue on neurocritical care. Guest Editor Jose I. Suarez, MD, FNCS, FANA, has brought together many renowned experts in the field to inform us of the state of the art of diagnosis and management of our critically ill neurologic patients.
The issue begins with an overview by Dr Matthew A. Koenig on the pathophysiology and management of cerebral edema, elevated intracranial pressure, and cerebral herniation syndromes, life-threatening processes for which diagnosis and management are integral to many of the disorders featured in the articles that follow. Next, Drs Wendy C. Ziai and J. Ricardo Carhuapoma provide an up-to-date review of the management of spontaneous intracerebral hemorrhage. Dr Susanne Muehlschlegel then reviews the diagnosis and management of subarachnoid hemorrhage, a highly morbid disorder in which rapid recognition and management are key components of neurologic practice. Moving on to ischemic stroke, Drs Chethan P. Venkatasubba Rao and Jose I. Suarez discuss the management of acute ischemic stroke and the specific issues related to management of patients with stroke in the neurocritical care unit.
Drs Sarah E. Nelson and Panayiotis N. Varelas discuss the current definitions and management of status epilepticus, refractory status epilepticus, and super-refractory status epilepticus. Next, Dr Alejandro A. Rabinstein reviews the systematic evaluation of patients in coma and provides the approach to, and avoidance of pitfalls in, the determination of brain death, followed by the article by Dr David B. Seder, who discusses the management and prognostication of comatose survivors of cardiac arrest, in which neurologists are critically involved.
Moving from disorders of the central nervous system to disorders of the peripheral nervous system, Drs Diana Greene-Chandos and Michel Torbey discuss the critical care of patients with neuromuscular disorders, including those with primary neuromuscular disorders admitted to the critical care unit and those with neuromuscular disorders that arise because of critical medical illness. In the final review article, Drs Lucia Rivera Lara and Hans Adrian Püttgen provide an overview of the status of multimodality monitoring in the neurocritical care unit and a glimpse into its future.
In the Ethical and Medicolegal Issues article, Drs Joseph S. Kass, Ariane Lewis, and Michael A. Rubin discuss the ethical considerations in end-of-life care in the face of clinical futility. This article segues nicely into the Practice Issues article in which Dr Christos Lazaridis discusses the importance of shared decision making in the neurocritical care unit. Next, Drs Marc R. Nuwer and Paul M. Vespa provide a practical overview of the important nuances of coding neurocritical care.
After reading the issue and taking the Postreading Self-Assessment and CME Test written by Drs Adam G. Kelly and James W. M. Owens Jr, you may earn up to 20 AMA PRA Category 1 CreditsTM toward self-assessment CME or, for Canadian participants, a maximum of 20 hours toward the Self-Assessment Program (Section 3) of the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada. Additional credit can be obtained by listening to Continuum Audio interviews associated with this and other Continuum issues, available to all subscribers, and completing tests on the Continuum Audio web platform or app. Continuum Audio is also accredited by the Royal College of Physicians and Surgeons of Canada.
My sincerest thanks to Dr Suarez and all the experts in neurocritical care who have provided such well-written contributions to this issue to inform all neurologists about the diagnosis, management, prognostication, and counseling of our critically ill neurologic patients.
As 2018 comes to a close along with my first term as editor-in-chief, I thought I would provide a brief update on my editorial vision. As most readers know, Continuum is designed as a curriculum, with 15 core topics covered in single issues over 3-year cycles. Each cycle includes a completely new take on each of the core topics; when I discuss the planning for each issue with guest editors, I ask them to cover “everything a practicing neurologist needs to know now” about the topic, regardless of what was covered in the previous curriculum cycle. This ensures that each new issue provides readers with a state-of-the-art, comprehensive review of each category of disorders, so that you can remain up-to-date in the diagnosis and management of those disorders and access a single print and digital resource on these conditions whenever and wherever you need it. My philosophy is to be as inclusive as possible within each topic and avoid holes in the curriculum, even at the expense of often physically larger issues. We have also worked to ensure that the three noncore topics in each cycle are carefully chosen based on both gaps in the curricular cycle as well as timeliness. We look forward to continuing to hone the curriculum so that all neurologists have a one-stop trusted source to inform the diagnosis and management of the disorders neurologists encounter in practice.
The print version of Continuum underwent a tremendous redesign in 2018, including the striking artwork on the cover by British artist Peter Grundy. Although this redesign may have come as a shock, I am thankful for your open-mindedness and for the nice comments we’ve received from so many of you.
What might be less on your radar is that our website (ContinuumJournal.com) has also been redesigned, allowing for easier access to both the current issue and previous issues, given the new ability to more easily search for back issues by both year and topic. The website also integrates Continuum Audio, which can now be accessed by a direct click from each Continuum article. These interviews represent a remarkable added value to your subscription and another way of learning from the topic expert authors. We hope that readers will continue to explore the new website as a tool to access all the rich content of Continuum from any location, including at the point of care. The website is mobile responsive and easily accessible on your cell phones. Please report your feedback so that we can further enhance this important aspect of Continuum’s accessibility. Although print is here to stay for Continuum, the ability to use Continuum at the point of care (or anywhere) is an important and, as yet, underutilized function of this rich resource and critical to our vision in the next 4 years.
I feel incredibly privileged and am thankful to the American Academy of Neurology to be able to continue to provide editorial leadership for the next 4 years and look forward to positioning the journal and its future leadership for further success for the next many years.
Dr Jose I. Suarez has brought together many renowned experts in the field to inform us of the state of the art of diagnosis and management of our critically ill neurologic patients.
—STEVEN L. LEWIS, MD, FAAN