Study guide
1.4 How to Use This Independent Study Guide
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)
1.4 How to Use This Independent Study Guide
Key Takeaways Explain This Topic AI
This is independent ExamFinch teaching covering topics listed in the ABPN content specifications; it is not an ABIM or ABPN product and does not claim official approval, review, or partnership.
The 27-chapter guide maps to five domains: Principles (chapters 2–13), Diagnostics and procedures (14–17), Neurocritical diseases (18–25), Neurosurgical and perioperative complications (26), and Ethics, research, and practice-based learning (27).
Principles of neurocritical care carry 42–48% of the examination, so ICU-medicine topics — airway, shock, organ support, and neuropharmacology — deserve the largest study share.
Free ExamFinch practice questions are extra drill covering neurocritical care topics; they are not the 270-item Pearson VUE examination.
Study time is individual. Neither ABIM nor ABPN publishes a required hour count for this subspecialty, and this guide does not invent one.
Last updated: September 2026
How to use this independent study guide
Quick Answer: This is independent ExamFinch teaching that covers topics listed in the ABPN Content Specifications for Neurocritical Care. It is not an ABIM or ABPN product and does not claim official approval, review, or partnership. The 27-chapter sequence follows the five official domains, with chapters 2–13 carrying the 42–48% Principles share. Independent practice at /practice/abim-neurocritical-care is extra drill, not the Pearson VUE examination. Study time is individual; no official required hour count is published.
Internists fail this examination in two boring ways. The first is treating it as "the neurology boards with extra blood pressure." The Content Specifications devote 42–48% to principles of neurocritical care — which is ICU medicine, airway, shock, ventilation, renal replacement, infection, endocrine salt-water disorders, and neuropharmacology — and only 27–33% to named neurocritical diseases . The second is treating a 100-item practice bank as if it were the 270-item form. Use this chapter to lock logistics, then use the remaining 26 chapters to cover the outline, with time proportional to domain weight rather than proportional to what feels dramatic in the unit.
What "independent" means on this site
ExamFinch authors teaching that names the source document (the ABPN Content Specifications posted December 23, 2021; the Format and Scoring PDF updated December 15, 2021; ABIM's fee and score-report pages) and names the topics those documents list. That is not a claim of official approval. It is not a claim of partnership. It is not a claim that a chapter is equivalent to an ABIM tutorial or an ABPN committee item. When a sentence states a fee, a date, or a weight, it cites the board page or PDF that currently publishes that number. When a sentence teaches pathophysiology, it is ExamFinch teaching.
Do not describe this guide as an official syllabus. Do not tell a program director it is an ABPN course. Do not tell a credentialer it replaces the Pearson VUE appointment. The certificate still comes from your board after you pass the shared examination they administer.
Map of the 27 chapters onto the five domains
Chapter 1 (this chapter) is logistics only . It is not a scored domain. Chapters 2–27 cover the five content domains. Section counts inside those chapters follow the official weight: more pages where the outline is heavier.
- Chapters Guide title Domain Official weight
- 1 Introduction and Exam Overview Logistics Not a scored domain
- 2–13 ICU exam and physiology through hematology 01 Principles of neurocritical care 42–48%
14–17 Neuroimaging, EEG/EMG/CSF, neuromonitoring, brain death and bedside procedures 02 Diagnostic studies and procedural skills 13–17%
18–25 Coma through inflammatory disease, neuro-oncology, and special populations 03 Neurocritical care diseases 27–33%
- 26 Neurosurgical and perioperative complications 04 Neurosurgical and perioperative complications 3–7%
- 27 Ethics, prognostication, and organ donation 05 Ethics, research, and practice-based learning 3–7%
A finer chapter list for study blocking:
Chapter 2 — ICU neurological examination, cerebral physiology, CSF physiology.
Chapter 3 — Osmotic agents, antiseizure drugs, anesthetics, sedatives, analgesia, paralytics, antihypertensives, vasopressors, inotropes.
Chapter 4 — Thrombolytics, anticoagulants, antiplatelets, reversal after hemorrhage, airway and tracheostomy, mechanical ventilation.
Chapter 5 — Hemodynamic monitoring, mechanical circulatory support, shock.
Chapter 6 — Nutrition, temperature control, ICU prophylaxis, delirium, early mobility.
Chapter 7 — Polytrauma, long-bone injury and fat embolism, burns, electrical injury, hanging.
Chapter 8 — Pulmonary physiology, ARDS, PE, pneumonia, obstructive disease, pulmonary hypertension, bronchoscopy basics.
Chapter 9 — Cardiomyopathy, ACS, valves, arrhythmias, pacing, aortic dissection, cardiac ultrasound.
Chapter 10 — AKI, renal replacement, acid-base, electrolytes, sepsis, endocarditis, antimicrobials.
Chapter 11 — Pituitary apoplexy, diabetes insipidus, SIADH, cerebral salt wasting, thyroid and adrenal crisis, dysglycemia.
Chapter 12 — GI emergencies, mesenteric ischemia, abdominal compartment syndrome, liver failure.
Chapter 13 — Transfusion, coagulopathy, DIC, VTE, cellular therapies, TMA.
Chapter 14 — CT, MRI, perfusion, CTA/MRA, catheter angiography.
Chapter 15 — EEG (standard and processed), EMG basics, CSF analysis.
Chapter 16 — ICP monitoring, TCD, brain-tissue oxygen, multimodality monitoring.
Chapter 17 — Brain death, apnea testing, vascular access, thoracic echo, lung ultrasound.
Chapter 18 — Coma, anoxic injury, toxidromes, delirium, hypertensive encephalopathy, intracranial hypertension.
Chapter 19 — IV reperfusion, thrombectomy windows, malignant MCA, basilar occlusion.
Chapter 20 — Intracerebral, cerebellar, and intraventricular hemorrhage.
Chapter 21 — Aneurysmal and nonaneurysmal SAH, cerebral venous thrombosis, spinal cord infarction.
Chapter 22 — Vascular anomalies, TBI, extra-axial hematomas, dissection, carotid-cavernous fistula.
Chapter 23 — Spinal cord injury, unstable fractures, hydrocephalus, acute CNS infection.
Chapter 24 — Status epilepticus, Guillain-Barré syndrome, myasthenic crisis, critical illness neuromyopathy.
Chapter 25 — Fulminant demyelination, autoimmune encephalitis, neuro-oncology, pregnancy, transplant, pediatric patients.
Chapter 26 — Postoperative seizures, hemorrhage, ischemia, hyperperfusion, infection, CSF leak, pneumocephalus, drain complications.
Chapter 27 — Communication, advance directives, prognostication, palliative withdrawal, donation after cardiac death, donor care.
If you are an internist with a strong MICU year, chapters 5–13 will feel familiar and still deserve full passes, because that familiarity is where 42–48% of the examination lives. If you are tempted to skip them "because I already sat CCM," remember that CCM certification is an eligibility requirement on the IM route, not a waiver of Domain 1 items. If you are tempted to start at chapter 19 because stroke is why you chose the fellowship, keep stroke, but do not let chapters 19–21 consume half the calendar while chapter 8 (ARDS and PE) and chapter 10 (sepsis and AKI) sit unopened.
Suggested emphasis, not a required hour count
Neither ABIM nor ABPN publishes a required number of study hours for Neurocritical Care. This guide will not invent one. A fellow finishing ACGME NCC in June and testing in October has a different calendar from a practice-pathway intensivist who has been the neuro ICU attending for a decade and last opened a primer on processed EEG in 2018. Individualize.
What is published is the weight . A reasonable default, if you need a starting split of whatever time you actually have:
- Domain Weight Default share of your study time
- Principles (chapters 2–13) 42–48% About half
- Diseases (chapters 18–25) 27–33% About one-third
- Diagnostics (chapters 14–17) 13–17% About one-sixth
- Neurosurgical complications (chapter 26) 3–7% A short, complete pass
- Ethics and donation (chapter 27) 3–7% A short, complete pass
"Short" still means you can explain EVD overdrainage, hyperperfusion after carotid revascularization, the self-fulfilling prophecy in prognostication, and donation after cardiac death. Those domains are small, not optional. They are also poor places to spend 40% of a scarce month.
Work each chapter's quizzes as checks on the teaching you just read, then use independent practice questions as extra drill on the same topics. A missed practice item is a reason to reopen the matching chapter, not a reason to memorize a bank explanation as if it were a leaked key.
Practice questions: extra drill, not the real exam
Free ExamFinch practice lives at Neurocritical Care practice questions . That bank is a study tool. It is not :
- the 270-item Pearson VUE examination,
- an official ABPN pretest form,
- a substitute for ABIM eligibility, or
a source of unpublished pass rates or cut scores.
If the practice inventory happens to contain 100 items, that integer is a bank size. The examination you will sit still has 270 questions. Do not stop studying when you have "done all 100." Do not assume the live form is shorter because a website showed 100.
Official documents versus this guide
When fees, dates, or eligibility change, the board page wins. Recheck:
- ABPN Neurocritical Care
- ABPN Content Specifications
- ABPN Format and Scoring
- ABIM exam fees
- ABIM's Neurocritical Care policy and registration pages for the IM application file
Use this guide to learn the medicine and the published logistics. Use ABIM to apply. Use Pearson VUE to sit. Use the mailed score report, three months after the last exam date, to learn whether you certified.