Study guide
1.1 Current Exam Facts
ABIM Neurocritical Care Subspecialty Certification Exam
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1 Introduction & Exam Overview
1.1 Current Exam Facts 1.2 Eligibility, Practice Pathway, and the IM Training Route 1.3 Format, Scoring, Pearson VUE, and Score Reports 1.4 How to Use This Independent Study Guide
2 ICU Neurologic Exam, Cerebral Physiology, and CSF
2.1 Neurological Examination in the ICU 2.2 Cerebral Physiology, ICP, CBF, and Autoregulation 2.3 CSF Physiology
3 Core Neuropharmacology
3.1 Osmotic Agents 3.2 Anti-Seizure Drugs 3.3 Anesthetics, Sedatives, Analgesia, and Paralytics 3.4 Antihypertensives, Vasopressors, and Inotropes
4 Reperfusion Drugs, Airway, and Ventilation
4.1 Thrombolytics, Anticoagulants, and Antiplatelets 4.2 Reversal of Anticoagulation After Acute Hemorrhage 4.3 Airway Management and Tracheostomy 4.4 Mechanical Ventilation
5 Hemodynamics and Shock
5.1 Hemodynamic Monitoring 5.2 IABP, Temporary VADs, LVAD, and ECMO 5.3 Diagnosis and Management of Shock
6 Nutrition, Temperature, and ICU Prophylaxis
6.1 Nutrition (01.J) 6.2 Temperature Control (01.K) 6.3 ICU Prophylaxis, Delirium, and Early Mobility (01.L)
7 General Trauma
7.1 Emergency Evaluation of Polytrauma, Chest, and Abdominal Trauma 7.2 Long-Bone Fractures and Fat Embolism 7.3 Burns, Electrical Injury, and Hanging/Strangulation
8 Pulmonary Critical Care
8.1 Pulmonary Physiology and ARDS (01.N.1–2) 8.2 PE, Pneumonia, and Pulmonary Edema (01.N.3, 7–8) 8.3 COPD, Asthma, PAH, and Bronchoscopy Basics (01.N.4–6, 9)
9 Cardiovascular Critical Care
9.1 Cardiovascular Physiology, Stress Cardiomyopathy, ACS, and Valves 9.2 Arrhythmias and Pacing 9.3 Acute Aortic Dissection and Cardiac Ultrasound
10 Renal and Infectious Disease
10.1 AKI, RRT, and Renal Drug Dosing 10.2 Acid-Base and Electrolyte Disorders 10.3 Severe Sepsis, Septic Shock, and Infective Endocarditis 10.4 Antimicrobial Use and Infection in the Immunosuppressed
11 Endocrine and Salt-Water Disorders
11.1 Pituitary Apoplexy, DI, and Panhypopituitarism (01.R.1–4) 11.2 SIADH and Cerebral Salt Wasting (01.R.5–6) 11.3 Thyrotoxicosis, Myxedema, Adrenal Crisis, and Dysglycemia (01.R.7–9)
12 Gastrointestinal Critical Care
12.1 GI Physiology, Acute Abdomen, Bleed, Ileus, and Perforation (01.S.1–5) 12.2 Mesenteric Ischemia and Abdominal Compartment Syndrome (01.S.6–7) 12.3 Fulminant Liver Failure, Cirrhosis Decompensation, and Hepatic Dosing (01.S.8–10)
13 Hematologic Disorders
13.1 Anemia, Transfusion, Thrombocytopenia, Coagulopathy, and DIC (01.T.1–4) 13.2 VTE in the Neuro ICU (01.T.5) 13.3 Chemo/Immune, SCT, CAR-T, Sickle Cell, and TMA (01.T.6–10)
14 Neuroimaging
14.1 CT of Brain and Spine 14.2 MRI and CT/MR Perfusion 14.3 Noninvasive Angiography and Catheter Angiography
15 EEG, EMG, and CSF Analysis
15.1 EEG, Standard and Processed (02.B) 15.2 Basic EMG Interpretation (02.G) 15.3 CSF Analysis (02.H)
16 ICP, TCD, and Multimodality Monitoring
16.1 ICP Monitoring (02.C) 16.2 Transcranial Doppler (02.D) 16.3 Brain-Tissue Oxygen and Multimodality Monitoring (02.E–F)
17 Brain Death and Bedside Procedures
17.1 Brain Death Prerequisites and Clinical Exam (02.I) 17.2 Apnea Testing and Ancillary Studies (02.I) 17.3 Vascular Access, Thoracic Echo, and Lung Ultrasound (02.J–L)
18 Coma, Anoxia, and Intracranial Hypertension
18.1 Coma and Other States of Altered Consciousness (03.A) 18.2 Global Anoxia-Ischemia and Post-Resuscitation Encephalopathy (03.A.1) 18.3 Toxidromes, ICU Delirium, and Hypertensive Encephalopathy (03.A.2–4) 18.4 Intracranial Hypertension as a Disease State (03.B)
19 Acute Ischemic Stroke
19.1 IV Reperfusion Therapy (03.C.3) 19.2 Mechanical Thrombectomy Windows and Imaging Selection (03.C.3) 19.3 Malignant Hemispheric Infarction and Basilar Artery Occlusion (03.C.1–2)
20 Intraparenchymal Hemorrhage
20.1 Intracerebral Hematoma (03.D.1) 20.2 Cerebellar Hematoma (03.D.2) 20.3 Intraventricular Hemorrhage (03.D.3)
21 SAH, CVST, and Spinal Cord Infarction
21.1 Aneurysmal Subarachnoid Hemorrhage (03.E.1) 21.2 Non-Aneurysmal SAH (03.E.2) 21.3 Cerebral Venous Sinus Thrombosis (03.F) 21.4 Spinal Cord Infarction (03.G)
22 Vascular Anomalies and Traumatic Brain Injury
22.1 Unruptured Aneurysm, Cavernoma, AVM, and Dural AVF (03.H) 22.2 Diffuse Axonal Injury and Cerebral Contusions (03.I.1–2) 22.3 Epidural Hematoma, Subdural Hematoma, and Penetrating Injury (03.I.3–4, 7) 22.4 Arterial Dissection and Carotid-Cavernous Fistula (03.I.5–6)
23 Spine, Hydrocephalus, and CNS Infection
23.1 Spinal Cord Injury, Central Cord, and Neurogenic Shock (03.J) 23.2 Unstable Spine Fractures (03.K) 23.3 Hydrocephalus and CSF Diversion (03.L) 23.4 Acute CNS Infections (03.M)
24 Seizures and Neuromuscular Emergencies
24.1 Status Epilepticus and Seizures (03.N) 24.2 Guillain-Barré Syndrome (03.O.1) 24.3 Myasthenic Crisis (03.O.2) 24.4 Motor Neuron Disease, Acute Myopathies, Rhabdomyolysis, and CINM (03.O.3–6)
25 Inflammatory Disease, Neuro-Oncology, and Special Populations
25.1 Fulminant Demyelinating Diseases (03.P) 25.2 Autoimmune Encephalitis and Acute Autonomic Hyperactivity (03.Q–R) 25.3 Neuro-Oncology and Treatment Complications (03.S) 25.4 Pregnancy/Post-Partum, Post-Transplant, and Pediatric Patients (03.T–U)
26 Neurosurgical and Perioperative Complications
26.1 Postoperative Seizures, Hemorrhage, Ischemia, and Hyperperfusion (04.A, C, D, H) 26.2 Infection, CSF Leak, and Pneumocephalus (04.B, E, F) 26.3 Complications of EVD and Lumbar Drain (04.G, I)
27 Ethics, Prognostication, and Organ Donation
27.1 Communication, Decision-Makers, Advance Directives, and DNR (05.A, B, G) 27.2 Uncertainties of Prognostication and the Self-Fulfilling Prophecy (05.C) 27.3 Palliative Care, Withdrawal, Withholding, and Futility (05.D–F) 27.4 Donation After Cardiac Death and Care of the Organ Donor (05.H–I)
1.1 Current Exam Facts
Key Takeaways Explain This Topic AI
ABPN administers the shared ABMS Neurocritical Care examination jointly developed by ABA, ABEM, ABIM, ABNS, and ABPN; ABIM diplomates apply through ABIM.
The ABPN Content Specifications posted December 23, 2021, and still linked for the October 2026 sitting, specify 270 one-best-answer questions.
Official domain weights are Principles 42–48%, Diagnostics and procedures 13–17%, Neurocritical diseases 27–33%, Neurosurgical and perioperative complications 3–7%, and Ethics, research, and practice-based learning 3–7%.
The 2026 administration is October 5–9 at Pearson VUE; the next sitting is 2028 (biennial). The first ABMS administration was 2021.
ABIM publishes a Neurocritical Care exam fee of $2,995; ABPN's initial neurologist subspecialty fee is $1,900 — do not mix the two price lists.
Last updated: September 2026
Current exam facts for ABIM Neurocritical Care
Quick Answer: The American Board of Medical Specialties (ABMS) Neurocritical Care examination is a shared 270 -question computer-based test jointly developed by the American Board of Anesthesiology ( ABA ), the American Board of Emergency Medicine ( ABEM ), the American Board of Internal Medicine ( ABIM ), the American Board of Neurological Surgery ( ABNS ), and the American Board of Psychiatry and Neurology ( ABPN ). ABPN administers the examination. ABIM diplomates apply through ABIM and currently pay ABIM's published Neurocritical Care fee of $2,995 . The 2026 window is October 5–9 at Pearson VUE ; the next administration is 2028 .
Neurocritical care as an ABMS subspecialty is the comprehensive, multisystem care of the critically ill patient with neurologic disease or a neurologic complication of critical illness. The certificate is not a state medical license. Your license remains the legal authority to practice. Passing this examination documents that you met a participating board's eligibility rules and demonstrated the knowledge those boards test on one shared computer-based form.
ExamFinch provides independent teaching covering topics listed in the ABPN Content Specifications for this examination. This guide is not an ABIM product and not an ABPN product. Independent Neurocritical Care practice questions are a study bank, not the 270-item Pearson VUE form.
Who writes the exam, and who do you apply to?
The examination is developed jointly by five ABMS member boards. Joint development does not mean five different tests. It means one content outline and one computer-based examination, with each board remaining responsible for its own diplomates' applications, fees, and score-report mailing.
- Board Abbreviation How a diplomate of that board applies
- American Board of Anesthesiology ABA Through ABA
- American Board of Emergency Medicine ABEM Through ABEM
- American Board of Internal Medicine ABIM Through ABIM
- American Board of Neurological Surgery ABNS Through ABNS
- American Board of Psychiatry and Neurology ABPN Through ABPN
ABPN administers the shared examination. That administrative fact is easy to misread as "I must hold ABPN neurology certification." You do not. An ABIM internist who meets ABIM's neurocritical care rules applies through ABIM , pays ABIM's fee, and receives ABIM's score communication, while sitting the same 270-item examination ABPN delivers at Pearson VUE.
ABMS approved the subspecialty certificate in June 2018 . The first ABMS administration was 2021 . The examination is biennial , not annual. Missing the October 2026 window means waiting for 2028 . There is currently no published limit on how many times an applicant may apply to take initial certification in this subspecialty; that is not a study strategy, only a reminder that a fail does not create a secret lifetime bar.
Item count: 270, not 100
The official ABPN Content Specifications , posted December 23, 2021 and still the document ABPN links for the October 2026 examination, state Number of questions: 270 . The items are one-best-answer multiple-choice questions.
The most expensive logistics error in this chapter is treating a 100 -item practice inventory, or a stale local summary of "about 100 questions in 8.5 hours," as the live examination. Those figures describe neither the Content Specifications nor the Format and Scoring PDF. The live examination is 270 questions in five stand-alone sections of 54 . If a blog, a coworker, or an outdated exam-information page still says 100 items, discard that number for this credential.
270 items in five sections of 54 is also the reason this is a full-day Pearson appointment, not a short quiz. Section 1.3 walks through the clock. Here the fact you must not lose is the item count .
Domain weights for the October 2026 outline
The same December 23, 2021 specifications publish five domains with ranges , not single integers. ABPN does not promise that every form hits the exact midpoint. Use the ranges when you divide study time. The pie chart in this section uses midpoints (45, 15, 30, 5, 5) only so the slices sum to 100 and you can see relative size at a glance.
Domain Official weight Chart midpoint What internists often underestimate
1. Principles of neurocritical care 42–48% 45 Airway, shock, mechanical ventilation, AKI, ICU prophylaxis, neuropharmacology
2. Diagnostic studies and procedural skills 13–17% 15 CT/MRI/angiography, EEG, ICP and TCD, ultrasound, brain death, vascular access
3. Neurocritical care diseases 27–33% 30 Stroke, ICH, SAH, TBI, status epilepticus, neuromuscular crisis, CNS infection
4. Neurosurgical and perioperative complications 3–7% 5 Postoperative hemorrhage or ischemia, CSF leak, EVD and lumbar-drain problems
5. Ethics, research, and practice-based learning 3–7% 5 Prognostication, withdrawal, donation after cardiac death, identifying decision-makers
Total 100% 100
Internists who "only review stroke" under-weight Domain 1. ARDS, vasopressors, renal replacement, endocrine salt-water disorders, and DVT prophylaxis sit in Principles of neurocritical care , not in the named-disease list. Conversely, spending half the calendar on EVD troubleshooting over-weights a 3–7% domain. On a 270-item form, 45% is about 122 items and 5% is about 14 items. Those integers are planning aids, not a promise that your form contains those exact counts. Research and pretest items are mixed in and unscored (Section 1.3).
2026 dates, Pearson VUE, and the 2028 cycle
ABPN's neurocritical care page lists choice of dates October 5–9, 2026 . Delivery is entirely computer-based at Pearson VUE . The next choice of dates is 2028 . This is not continuous, year-round testing and not a Prometric product.
For ABPN neurologist applicants, ABPN currently publishes a separate calendar: application available December 18, 2025 ; deadline April 9, 2026 (11:59 p.m. CT); late deadline April 16, 2026 ; Pearson VUE registration opens August 6, 2026 . ABIM diplomates do not use that neurologist portal calendar. Application deadlines may differ by board. Register on ABIM's published dates for an ABIM file, then schedule the Pearson VUE appointment ABIM authorizes.
Fees: do not mix ABIM and ABPN price lists
- Who is applying Who you pay Published examination fee Source
- ABIM diplomate ABIM $2,995 ABIM exam fees and refund policies
- ABPN neurologist (initial subspecialty ) ABPN $1,900 ABPN fee schedule posted January 5, 2026
Do not send $1,900 to ABPN as an ABIM applicant , and do not assume ABIM charges $1,900 because a neurology colleague quoted the ABPN subspecialty line. ABPN's $1,945 initial specialty fee is a different product — primary psychiatry or neurology certification — not this subspecialty examination. The $250 figure that appears in Section 1.3 is ABIM's rescore fee, not the examination fee.
ABPN also lists miscellaneous amounts on its own schedule (for example a $500 late application fee and a $200 Pearson reseating fee). Those are ABPN lines. ABIM candidates follow ABIM fee and refund policy.
What this section does not invent
Neither the ABPN Format and Scoring PDF nor ABIM's published scoring pages give a percent-correct passing score for this examination. This guide does not invent an unpublished ABIM first-time pass rate for the subspecialty. Plan to the 270-item, five-domain outline rather than to a hallway percentage.
Re-check these documents before you register:
- ABPN Neurocritical Care
- ABPN Content Specifications (posted December 23, 2021)
- ABIM exam fees and refund policies