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Exam Number : NCC
Exam Name : Certified in NeuroCritical Care (ABEM)
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The following are specific diseases, conditions, and clinical syndromes commonly managed by a neurointensivist:
A. Cerebrovascular Diseases
1. Infarction and ischemia
Massive hemispheric infarction
Basilar artery occlusion and stenosis
Carotid artery occlusion and stenosis
Crescendo TIAs
Occlusive vasculopathies (Moya-Moya, sickle cell)
Spinal cord infarction
2. Intracerebral hemorrhage
Supratentorial
Cerebellar
Brainstem
Intraventricular
3. Subarachnoid hemorrhage - aneurysmal and other Vascular malformations
Arteriovenous malformations
AV fistulas
Cavernous malformations
Developmental venous anomalies
4. Dural sinus thrombosis
5. Carotid-cavernous fistulae
6. Cervical and cerebral arterial dissections
B.Neurotrauma
1. Traumatic brain injury
"Diffuse axonal injury"
Epidural hematoma
Subdural hematoma
Skull fracture
Contusions and lacerations
Penetrating craniocerebral injuries
Traumatic subarachnoid hemorrhage
2. Spinal cord injury
Traumatic injury (transection, contusion, concussion)
Vertebral fracture and ligamentous instability
C. Disorders, Diseases, Seizures, and Epilepsy
1 . Seizures and epilepsy
Status epilepticus (SE) Convulsive
Non-convulsive (partial-complex and "subtle" secondarily generalized SE) Myoclonic
2. Neuromuscular diseases
Myasthenia gravis
Guillain-Barre syndrome
ALS
Rhabdomyolysis and toxic myopathies
Critical illness myopathy and neuropathy
3. Infections
Encephalitis (viral, bacterial, parasitic)
Meningitis (viral, bacterial, parasitic)
Brain and spinal epidural abscess
4. Toxic-metabolic disorders
Neuroleptic malignant syndrome/malignant hyperthermia
Serotonin syndrome
Drug overdose and withdrawal (e.g., barbiturates, narcotics, alcohol, cocaine, acetaminophen).
Temperature related injuries (hyperthermia, hypothermia)
5. Inflammatory and demyelinating diseases
Multiple sclerosis (Marburg variant, transverse myelitis)
Neurosarcoidosis
Acute disseminated encephalomyelitis (ADEM)
CNS vasculitis
Chemical or sterile meningitis (i.e. posterior fossa syndrome, NSAID induced)
Central pontine myelinolysis
Others
6. Neuroendocrine disorders
Pituitary apoplexy
Diabetes insipidus (including triple phase response)
Panhypopituitarism
Thyroid storm and coma
Myxedema coma
Addisonian crisis
D. Neuro-oncology
1 . Brain tumors and metastases
2. Spinal cord tumors and metastases
3. Carcinomatous meningitis
4. Paraneoplastic syndromes
E.Encephalopathies
1. Eclampsia, including HELLP Syndrome
2. Hypertensive encephalopathy
3. Hepatic encephalopathy
4. Uremic encephalopathy
5. Hypoxic-ischemic and anoxic encephalopathy
6. MELAS
F.Clinical syndromes
1.Coma
2. Herniation syndromes with monitoring & ICP
3. Elevated intracranial pressure and Intracranial hypotension/hypovolemia
4. Hydrocephalus detection & treatment
5. Cord compression
6. Death by neurologic criteria, end of life issues, and organ donation
7. Vegetative state
8. Dysautonomia (cardiovascular instability, central fever, hyperventilation)
9. Reversible posterior leukoencephalopathy
10. Psychiatric emergencies (psychosis)
G. Perioperative Neurosurgical Care
H.Pharmacotherapeutics
II. General Critical Care: Pathology, Pathophysiology, and Therapy
A. Cardiovascular Physiology, Pathology, Pathophysiology, and Therapy
1. Shock (hypotension) and its complications (vasodilatory and cardiogenic)
2. Myocardial infarction and unstable coronary syndromes
3. Neurogenic cardiac disturbances (ECG changes, stunned myocardium)
4. Cardiac rhythm and conduction disturbances; use of antiarrhythmic medications; indications for and types of pacemakers
5. Pulmonary embolism
6. Pulmonary edema: cardiogenic versus noncardiogenic (including neurogenic)
7. Acute aortic and peripheral vascular disorders (dissection, pseudoaneurysm)
8. Recognition, evaluation and management of hypertensive emergencies and urgencies
9. Calculation of derived cardiovascular parameters, including systemic and pulmonary vascular resistance, alveolararterial gradients, oxygen transport and consumption
B.Respiratory Physiology, Pathology, Pathophysiology and Therapy
1.Acute respiratory failure
Hypoxemic respiratory failure (including ARDS)
Hypercapnic respiratory failure
Neuromuscular respiratory failure
2. Aspiration
3. Bronchopulmonary infections
4. Upper airway obstruction
5. COPD and status asthmaticus, including bronchodilator therapy
6. Neurogenic breathing patterns (central hyperventilation, Cheyne-Stokes respirations)
7. Mechanical ventilation
Positive pressure ventilation (BIPAP)
PEEP, CPAP, inverse ratio ventilation, pressure support ventilation, pressure control, and non- invasive ventilation
Negative pressure ventilation
Barotrauma, airway pressures (including permissive hypercapnia)
Criteria for weaning and weaning techniques
8. Pleural Diseases
Empyema
Massive effusion
Pneumothorax
9. Pulmonary hemorrhage and massive hemoptysis
10. Chest X-ray interpretation
11. End tidal C02 monitoring
12. Sleep apnea
13. Control of breathing
C. Renal Physiology,Pathology, Pathophysiology and Therapy
1.Renal regulation of fluid and water balance and electrolytes
2.Renal failure: Prerenal, renal, and postrenal
3.Derangements secondary to alterations in osmolality and electrolytes
4. Acid-base disorders and their management
5.Principles of renal replacement therapy
6. Evaluation of oliguria and polyuria
7.Drug dosing in renal failure
8. Management of rhabdomyolysis
9. Neurogenic disorders of sodium and water regulation (cerebral salt wasting and SIADH).
D. Metabolic and Endocrine Effects of Critical Illness
1. Enteral and parenteral nutrition
2. Endocrinology
Disorders of thyroid function (thyroid storm, myxedema coma, sick euthyroid syndrome)
Adrenal crisis
Diabetes mellitus
Ketotic and hyperglycemic hyperosmolar coma Hypoglycemia
3. Disorders of calcium and magnesium balance
4. Systemic Inflammatory Response Syndrome (SIRS)
5. Fever, thermoregulation, and cooling techniques
E.Infectious Disease Physiology, Pathology, Pathophysiology and Therapy
1. Antibiotics
Antibacterial agents
Antifungal agents
Antituberculosis agents
Antiviral agents
Antiparasitic agents
2. Infection control for special care units
Development of antibiotic resistance
Universal precautions
Isolation and reverse isolation
3. Tetanus and botulism
4. Hospital acquired and opportunistic infections in the critically ill
5. Acquired Immune Deficiency Syndrome (AIDS)
6. Evaluation of fever in the ICU patient
7. Central fever
8. Interpretation of antibiotic concentrations, sensitivities
F.Physiology, Pathology, Pathophysiology and therapy of Acute Hematologic Disorders
1 . Acute defects in hemostasis
Thrombocytopenia, thrombocytopathy
Disseminated intravascular coagulation
Acute hemorrhage (GI hemorrhage, retroperitoneal hematoma)
Iatrogenic coagulopathies (warfarin and heparin induced)
2. Anticoagulation and fibrinolytic therapy
3. Principles of blood component therapy (blood, platelets, FFP)
4. Hemostatic therapy (vitamin K, aminocaproic acid, protamine, factor VIla)
5. Prophylaxis against thromboembolic disease
6. Prothrombotic states
G. Physiology, Pathology, Pathophysiology and Therapy of Acute Gastrointestinal (GI) and Genitourinary (GU)
Disorders
1. Upper and lower gastrointestinal bleeding
2. Acute and fulminant hepatic failure (including drug dosing)
3. Ileus and toxic megacolon
4. Acute perforations of the gastrointestinal tract
5. Acute vascular disorders of the intestine, including mesenteric infarction
6. Acute intestinal obstruction, volvulus
7. Pancreatitis
8. Obstructive uropathy, acute urinary retention
9. Urinary tract bleeding
H. Immunology and Transplantation
1. Principles of transplantation (brain death, organ donation, procurement, maintenance of organ donors, implantation)
2. Immunosuppression, especially the neurotoxicity of these agents
I. General Trauma and Burns
1. Initial approach to the management of multisystem trauma
2. Skeletal trauma including the spine and pelvis
3. Chest and abdominal trauma - blunt and penetrating
4. Burns and electrical injury
J. Monitoring
1. Neuromonitoring
2. Prognostic, disease severity and therapeutic intervention scores
3. Principles of electrocardiographic monitoring
4. Invasive hemodynamic monitoring
5. Noninvasive hemodynamic monitoring
6. Respiratory monitoring (airway pressure, intrathoracic pressure, tidal volume, pulse oximetry, dead space, compliance, resistance, capnography)
7. Metabolic monitoring (oxygen consumption, carbon dioxide production, respiratory quotient)
8. Use of computers in critical care units for multimodality monitoring
K. Administrative and Management Principles and Techniques
1. Organization and staffing of critical care units
2. Collaborative practice principles, including multidisciplinary rounds and management
3. Emergency medical systems in prehospital care
4. Performance improvement, principles and practices
5. Principles of triage and resource allocation, bed management
6. Medical economics: health care reimbursement, budget development
L. Ethical and Legal Aspects of Critical Care Medicine
1. Death and dying
2. Forgoing life-sustaining treatment and orders not to resuscitate
3. Rights of patients, the right to refuse treatment
4. Living wills, advance directives; durable power of attorney
5. Terminal extubation and palliative care
6. Rationing and cost containment
7. Emotional management of patients, families and caregivers
8. Futility of care and the family in denial
M. Principles of Research in Critical Care
1. Study design
2. Biostatistics
3. Grant funding and protocol writing
4. Manuscript preparation
5. Presentation preparation and skills
6. Institutional Review Boards and HIPAA
Ill. Procedural Skills
A. General Neuro-Critical Care
1 . Central venous catheter placement; dialysis catheter placement
2. Pulmonary artery catheterization
3. Management of mechanical ventilation, including CPAP/BiPAP ventilation
4. Administration of vasoactive medications (hemodynamic augmentation and hypertension lysis)
5. Maintenance airway and ventilation in nonintubated, unconscious patients
6. Interpretation and performance of bedside pulmonary function tests
7. Direct laryngoscopy
8. Endotracheal intubation
9. Shunt and ventricular drain tap for CSF sampling
10. Performance and interpretation of transcranial Doppler
11. Administration of analgosedative medications, including conscious sedation and barbiturate anesthesia
12. Interpretation of continuous EEG monitoring
13. Interpretation and management of ICP and CPP data
14. Jugular venous bulb catheterization
15. Interpretation of Sjv02 and Pbt02 data
16. Management of external ventricular drains
I 7. Management of plasmapheresis and IVIG
18. Administration of intravenous and intraventricular thrombolysis
19. Interpretation of CT and MR standard neuroimaging and perfusion studies and biplane contrast neuraxial angiography
20. Perioperative and postoperative clinical evaluation of neurosurgical and interventional neuroradiology patients
21. Performance of lumbar puncture and interpretation of cerebrospinal fluid results
22. Induction and maintenance of therapeutic coma and hypothermia



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