Pediatric Neurocritical Care

ABPN Neurocritical Care Study Guide Exam

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1 Chapter 1: Neurologic Examination & Coma Assessment in the ICU

Current Examination, Blueprint & Preparation Neurologic Examination in Critically Ill Patients Coma Evaluation & Consciousness Alterations Delirium & Toxic-Metabolic Encephalopathy in the ICU

2 Chapter 2: Cerebral Physiology & Intracranial Dynamics

Cerebral Blood Flow, Metabolism & Autoregulation Intracranial Pressure & Compliance Cerebral Edema & Herniation Syndromes

3 Chapter 3: Intracranial Hypertension & Cerebral Perfusion Management

Tiered ICP Management Protocols Hyperosmolar Therapy & Fluid Management Advanced & Refractory ICP Interventions

4 Chapter 4: Airway, Mechanical Ventilation & Pulmonary ICU Management

Emergency Airway Management & Neuro-Intubation Mechanical Ventilation Strategies in Acute Brain Injury Tracheostomy & Ventilator Weaning in Neurocritical Care Pulmonary Complications in the Neuro-ICU Obstructive Lung Disease, Pulmonary Hypertension & Bronchoscopy

5 Chapter 5: Hemodynamics, Shock & Cardiovascular Management

Hemodynamic Monitoring & Blood Pressure Targets Vasoactive Agents: Inotropes, Vasopressors & Antihypertensives Cardiac Complications of Brain Injury

6 Chapter 6: Neuropharmacology, Analgesia & Sedation

ICU Sedation & Analgesia Neuromuscular Blockade & Monitoring Propofol Infusion Syndrome & Drug Toxicities Antiseizure Drug Pharmacology in the ICU

7 Bleeding, Thrombosis & Hematologic Emergencies

Warfarin & Heparin Reversal Direct Oral Anticoagulant (DOAC) Reversal Antiplatelet Management & Platelet Dysfunction Venous Thromboembolism Prophylaxis & Management Transfusion, Coagulopathy, TMA & Cellular-Therapy Neurotoxicity

8 Chapter 8: Systemic ICU Care, Fluids, Electrolytes & Endocrine

Hyponatremia & Osmoregulation: SIADH vs Cerebral Salt Wasting Diabetes Insipidus, Hypernatremia & Endocrine Crises Critical Care Prophylaxis, Nutrition & Infection Prevention

9 Systemic Trauma & Environmental Injury

Polytrauma, Chest Injury & Abdominal Hemorrhage Burns, Electrical Injury & Hanging

10 Cardiac Emergencies & Mechanical Support

IABP, Ventricular Devices & ECMO Acute Coronary, Valvular, Rhythm & Aortic Emergencies

11 Kidney Injury, Acid–Base & Renal Replacement

Acute Kidney Injury & Renal Drug Clearance Acid–Base Disorders, Electrolytes & Renal Replacement

12 Systemic Infection & Endocrine Emergencies

Sepsis, Endocarditis & Antimicrobial Principles Thyroid, Adrenal & Dysglycemic Emergencies

13 Gastrointestinal & Hepatic Emergencies

Acute Abdomen, GI Bleeding & Abdominal Compartment Syndrome Acute Liver Failure, Cirrhosis & Hepatic Drug Effects

14 Chapter 9: Neuroimaging in the Neuro-ICU

Non-Contrast CT & CT Angiography CT Perfusion & Advanced Perfusion Imaging Magnetic Resonance Imaging in Critical Illness

15 Chapter 10: Electrophysiology & Neuromonitoring

Continuous EEG & ACNS Standardized Critical Care Terminology Invasive Neuromonitoring: ICP & External Ventricular Drains Multimodal Monitoring: PbtO2, Microdialysis & Transcranial Doppler

16 Angiography, Electrodiagnosis & CSF Analysis

Conventional Angiography & Cranial–Spinal Shunts EMG, Nerve Conduction & Acute Muscle Disease CSF Analysis: Infection, Inflammation & Hemorrhage

17 Chapter 11: Bedside Procedures, Ultrasound & Death by Neurologic Criteria

Critical Care Procedural Skills Critical Care Ultrasound & Echocardiography Determination of Death by Neurologic Criteria

18 Chapter 12: Acute Ischemic Stroke & Reperfusion Therapies

Acute Ischemic Stroke Management & Thrombolysis Endovascular Thrombectomy & Large Vessel Occlusion Malignant Hemispheric & Cerebellar Infarction

19 Chapter 13: Spontaneous Intracerebral Hemorrhage & Intraventricular Hemorrhage

Acute Intraparenchymal Hemorrhage Management Intraventricular Hemorrhage & Hydrocephalus Surgical Evacuation & Minimally Invasive Surgery in ICH

20 Chapter 14: Aneurysmal Subarachnoid Hemorrhage & Delayed Cerebral Ischemia

Aneurysmal Subarachnoid Hemorrhage: Acute Resuscitation & Securing Delayed Cerebral Ischemia & Cerebral Vasospasm Non-Aneurysmal Subarachnoid Hemorrhage & Vascular Malformations

21 Venous, Spinal & Traumatic Vascular Disease

Cerebral Venous Thrombosis & Spinal Cord Infarction Traumatic Dissection, Carotid–Cavernous Fistula & Penetrating Injury

22 Chapter 15: Traumatic Brain & Spinal Cord Injury

Severe Traumatic Brain Injury & Contusions Acute Traumatic Spinal Cord Injury & Neurogenic Shock Spine Trauma, Fractures & Cord Syndromes

23 Chapter 16: Status Epilepticus, Seizures & Neuromuscular Emergencies

Status Epilepticus: Convulsive & Non-Convulsive Refractory & Super-Refractory Status Epilepticus Acute Neuromuscular Respiratory Failure

24 Chapter 17: Post-Cardiac Arrest Care, CNS Infections & Encephalitis

Targeted Temperature Management & Post-Cardiac Arrest Care Post-Cardiac Arrest Neuroprognostication Acute CNS Infections, Encephalitis & Inflammatory Emergencies

25 Neuroinflammation & Neurooncology

Fulminant Demyelination & Autoimmune Encephalitis Brain, Spinal & Leptomeningeal Cancer Emergencies

26 Pregnancy, Transplantation & Pediatric Care

Pregnancy, Postpartum & Post-Transplant Neurologic Care Pediatric Neurocritical Care

27 Chapter 18: Neurosurgical & Perioperative Emergencies

Postoperative Neurosurgical Complications Device Complications: EVDs, Shunts & ICP Monitors Cerebral Hyperperfusion Syndrome & Post-Interventional Emergencies

28 Chapter 19: Ethics, Palliative Care & Organ Donation in the Neuro-ICU

Communication, Surrogate Decision-Making & Conflict Resolution Neuroprognostication Ethics, Withdrawal of Life Support & Palliative Care Organ Donation & Management of the Deceased Donor

Pediatric Neurocritical Care

Key Takeaways Explain This Topic AI

Assess pediatric circulation using age-appropriate thresholds and the full perfusion examination.

Pediatric severe-TBI guidance suggests treating ICP above 20 mm Hg and maintaining CPP at least 40 mm Hg, with age-sensitive targets commonly 40–50 mm Hg.

An open fontanelle or a reassuring early CT does not exclude intracranial hypertension.

Pediatric death determination requires the current pediatric examination, apnea-testing, prerequisite, and interval rules.

Last updated: October 2026

Children Are a Distinct Blueprint Population

The outline explicitly includes pediatric patients. The relevant task is to recognize when age changes physiology, disease likelihood, equipment, dosing, or interpretation. Infants and children have different airway anatomy, blood-pressure ranges, blood volume, glucose reserves, and developmental baselines. A behavior or examination that is abnormal for an adolescent may not be interpretable the same way in a young infant.

Use an age-appropriate resuscitation framework and obtain pediatric critical care expertise early for severe illness. Record age, weight, premorbid development, immunization and infection history, trauma mechanism, and potential exposures. Confirm units and maximum doses when calculating medication or fluid therapy. A tenfold decimal error can be especially consequential when small volumes and concentrated drugs are used.

Airway, Ventilation, and Circulation

Children can deteriorate rapidly with airway obstruction, hypoventilation, or shock. Select appropriately sized airway devices and confirm placement and ventilation. Avoid assuming that a displayed oxygen saturation excludes hypercapnia or inadequate ventilation. Assess work of breathing, respiratory pattern, gases when indicated, and the ability to protect the airway.

Hypotension can be a late sign of pediatric shock. Capillary refill, skin temperature, pulse quality, mental status, urine output, lactate trends, and pressure together inform perfusion. Age-based limits differ from adult thresholds. In severe TBI, prevent hypoxemia and inadequate cerebral perfusion while treating hemorrhage or other shock causes. Do not apply permissive hypotension indiscriminately to a child with brain injury.

Pediatric Severe TBI

The Brain Trauma Foundation's pediatric third-edition guideline is separate from the adult guideline. It suggests treating intracranial hypertension above 20 mm Hg and maintaining CPP at least 40 mm Hg; a target range around 40–50 mm Hg is considered, with infants toward the lower end and adolescents toward the upper end. These are guideline-based starting points with limited evidence, not a claim that a single pressure guarantees safety in every child.

• Adult-to-child transfer error Better reasoning
• Use adult ICP 22 mm Hg universally Consult pediatric guidance and the child's clinical situation
• Force adult CPP 60–70 in every infant Use age-sensitive pediatric perfusion goals
• An open fontanelle prevents dangerous ICP Examine and monitor for intracranial hypertension when indicated
• A normal initial CT excludes evolving injury Continue clinical assessment and repeat evaluation as needed

Hyperosmolar treatment requires weight-based protocols, electrolyte and renal monitoring, and response assessment. Avoid prophylactic severe hyperventilation and use emergency rescue ventilation only for an appropriate indication while definitive treatment is organized. Steroids do not treat traumatic cerebral edema. Decisions about ICP monitoring, surgery, seizure prophylaxis, nutrition, and sedation require pediatric application rather than simply copying an adult order set.

Seizures, Infection, and Inflammation

Age changes the differential for seizures and encephalopathy. Consider infection, metabolic and toxic causes, accidental or inflicted injury, vascular disease, and inflammatory conditions. Hypoglycemia must be recognized and treated promptly. A prolonged seizure requires rapid treatment using pediatric dosing and airway preparation; persistent impaired consciousness after motor activity stops can require EEG assessment for ongoing electrographic seizures.

Infants may have meningitis without classic neck stiffness, and immunocompromised children may have muted inflammatory findings. Start indicated empirical therapy without waiting for an unsafe or delayed LP. MRI and CSF studies are chosen for the syndrome and safety assessment. Pediatric ADEM and autoimmune encephalitis can cause substantial encephalopathy, movement abnormalities, autonomic dysfunction, or respiratory compromise and need coordinated immune and infectious evaluation.

Vascular Disease, Hydrocephalus, and Trauma

Pediatric stroke may involve arteriopathy, congenital or acquired cardiac disease, sickle cell disease, infection, dissection, or other mechanisms. The 2026 AHA/ASA AIS guideline includes pediatric interventional recommendations for selected patients; this does not make adult eligibility criteria universally applicable. Use pediatric stroke and neurointerventional expertise urgently rather than excluding treatment solely because the patient is a child.

Hydrocephalus and shunt malfunction can present with vomiting, irritability, headache, altered consciousness, or age-dependent examination changes. Compare with prior imaging and shunt history; normal-looking ventricular size does not always exclude malfunction. In suspected inflicted injury, prioritize resuscitation and objective assessment, involve the appropriate safeguarding team, and document findings without prematurely assigning a mechanism from one isolated sign.

Prognosis and Death Determination

Developmental recovery, premorbid function, family priorities, and the cause of injury matter in prognostic counseling. Do not use an adult cardiac-arrest biomarker cutoff or an adult score as a validated personal pediatric forecast. Distinguish uncertain neurologic prognosis from the separate legal and clinical determination of death.

The 2023 AAN/AAP/CNS/SCCM guideline specifies pediatric prerequisites, two independent examinations separated by at least 12 hours, and two apnea tests when they can be performed safely. It also has age- and injury-dependent observation requirements before evaluation. TCD is not an accepted pediatric ancillary test under that guideline. Refer to the dedicated death-determination section for the full framework; a simple adult checklist is insufficient.

Sources checked October 17, 2026: pediatric BTF guideline , 2023 death-determination guideline , and 2026 AIS guideline summary .