Guest Editor Dr Rabinstein has convened a distinguished group of neurocritical care experts to create a volume that, for all intents and purposes, should serve as our go-to resource for any of the many diagnostic, management, and counseling issues that arise while caring for our patients in the neurocritical care (or any intensive care) unit.
This issue of Continuum was developed to thoroughly inform us about the diagnosis and current management of our critically ill neurologic patients. With this important goal in mind, Guest Editor Dr Alejandro A. Rabinstein has convened a distinguished group of neurocritical care experts to create a volume that, for all intents and purposes, should serve as our go-to resource for any of the many diagnostic, management, and counseling issues that arise while caring for our patients in the neurocritical care (or any intensive care) unit.
Guest Editor Dr Alejandro A. Rabinstein has convened a distinguished group of neurocritical care experts to create a volume that, for all intents and purposes, should serve as our go-to resource for any of the many diagnostic, management, and counseling issues that arise while caring for our neurologic patients in the neurocritical care (or any intensive care) unit.
The issue begins with two articles that tackle the life-threatening hemorrhages so commonly encountered by neurologists in the neurocritical care unit, first with an article by Dr Jose I. Suarez, who discusses the diagnosis and management of subarachnoid hemorrhage, followed by Dr. Andrew M. Naidech’s article on the diagnosis and management of spontaneous intracerebral hemorrhage. Next, Dr W. David Freeman reviews intracranial pressure and its current management, of which knowledge and expertise are critically important for neurologists caring for patients with any of the many disorders that can lead to its elevation.
Taking a brief but important detour away from the CNS, Dr Rabinstein reviews acute neuromuscular respiratory failure, a life-threating problem that can occur in patients with primary neuromuscular disorders or as a complication of critical systemic illness, for which neurologists play a central role in evaluation and management.
Dr Kevin N. Sheth discusses the current recommendations for evaluation and management of ischemic swelling that may occur after hemispheric infarction, a potentially fatal complication that can affect so many of our patients with large territory ischemic strokes. Next, Dr Sara E. Hocker reviews the diagnosis of and the current management steps and options for the care of our patients in status epilepticus.
Dr David M. Greer then carefully and clearly reviews the many issues, uncertainties, and significant ongoing challenges with regard to our current and evolving management, assessment, and prognostication efforts in patients with cardiac arrest and postanoxic encephalopathy. In the subsequent article, Drs G. Bryan Young and Adrian M. Owen discuss the challenges in evaluation for potential of recovery of consciousness after traumatic brain injury or postanoxic encephalopathy, including the current definition of the minimally conscious state and the recent and striking recognition that some patients with traumatic brain injury who were previously thought to be in a vegetative state have been found on imaging to have cognitive responses. Dr Eelco F. M. Wijdicks next reviews the complexities of assessment and clinical diagnosis of brain death in patients who have sustained a catastrophic brain injury, a tremendously important responsibility that we neurologists undertake. In the final review article of the issue, Dr Jennifer E. Fugate reviews the major complications of neurosurgical and endovascular procedures that may involve our patients or patients for whom we may be consulted who have undergone such procedures.
In this issue’s Ethical Perspectives article, Drs Erik K. St. Louis and Richard R. Sharp provide a hypothetical case study as a springboard for an informative and thoughtful discussion of the complicated ethical issues involved in the controversial practice of organ donation after circulatory death. In the Practice Issues article, Dr Jessica D. Lee discusses the current and evolving role of advanced practice providers as members of the interprofessional team managing patients in the neurocritical care unit. Next, Drs Marc R. Nuwer and Paul M. Vespa review many of the considerations that neurologists need to be aware of with regard to critical care coding.
As with every issue of Continuum, a number of opportunities exist for CME. By taking the Postreading Self-Assessment and CME Test, created by Drs Eduardo E. Benarroch and Adam G. Kelly, after reading the issue, you may earn up to 12 AMA PRA Category 1 Credits™ toward self-assessment and CME. The Patient Management Problem, written by Dr Katharina Maria Busl, follows the case of a 41-year-old man who initially presents to the emergency department because of a severe diffuse encephalopathy and seizure. By following his case and answering multiple-choice questions corresponding to diagnostic and management decision points along the course of his evolving and worsening disorder, you will have the opportunity to earn up to 2 AMA PRA Category 1 CME Credits.
I want to give my sincerest thanks to Dr Rabinstein for the tremendous amount of work and care he provided in bringing this comprehensive volume to fruition and for bringing such an expert and experienced faculty together to impart their knowledge to us. Reading and referring to the clear and comprehensive articles in this issue will help ensure that we provide the most up-to-date diagnosis and management of our critically ill neurologic patients.
—Steven L. Lewis, MD, FAAN