Pregnancy, Postpartum & Post-Transplant Neurologic 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

Pregnancy, Postpartum & Post-Transplant Neurologic Care

Key Takeaways Explain This Topic AI

Persistent severe hypertension in pregnancy or postpartum requires urgent obstetric treatment; eclampsia is treated with magnesium sulfate unless a specific contraindication changes the plan.

PRES, RCVS, CVT, ischemic stroke, and hemorrhage are important pregnancy-associated neurologic differentials.

HELLP includes hemolysis, elevated liver enzymes, and low platelets and can overlap with other thrombotic microangiopathies.

Post-transplant encephalopathy may reflect infection, calcineurin-inhibitor toxicity, metabolic disease, seizures, or vascular complications.

Last updated: October 2026

Maternal Stabilization and Neurologic Diagnosis

Pregnancy and the postpartum period do not protect against ordinary stroke, hemorrhage, infection, or seizures. They add specific risks and affect medication and procedural choices. Coordinate obstetric, anesthesia, stroke, neurosurgical, and ICU care as indicated. Stabilize maternal airway, oxygenation, circulation, glucose, and seizures while evaluating the cause. Necessary time-sensitive brain imaging should not be withheld reflexively because the patient is pregnant; select the study and precautions with the treating teams.

Record gestational or postpartum timing, blood pressure, headache pattern, focal findings, seizures, medication exposures, and relevant obstetric symptoms. A new severe headache is not automatically migraine. Consider preeclampsia or eclampsia, PRES, RCVS, CVT, dissection, ischemic stroke, hemorrhage, pituitary disease, and infection. Several can coexist, and a familiar label does not exclude a second process.

Preeclampsia, Eclampsia, and HELLP

Preeclampsia involves pregnancy-associated hypertension with relevant proteinuria or organ dysfunction under obstetric diagnostic criteria. Neurologic symptoms can include persistent headache, visual disturbance, altered consciousness, or seizures. Eclampsia is a seizure syndrome in the appropriate setting after considering other causes. It can occur postpartum, and a preceding diagnosis of severe preeclampsia is not required for every presentation.

Treat persistent severe hypertension promptly; obstetric guidance uses systolic pressure at least 160 or diastolic pressure at least 110 mm Hg as severe thresholds. Common acute agents include labetalol, hydralazine, and immediate-release oral nifedipine under the appropriate protocol. Hydralazine is therefore not absolutely prohibited simply because a patient has neurologic symptoms. Avoid excessive reductions that impair maternal and placental perfusion.

Magnesium sulfate is central to seizure treatment and prevention in eclampsia. Monitor respiratory status, reflexes, renal function, and magnesium exposure. Toxicity can cause loss of reflexes, respiratory depression, and cardiovascular instability; stop the infusion and use appropriate supportive treatment and calcium when indicated. Myasthenia gravis and substantial renal dysfunction create particular hazards and require specialist adaptation. Persistent seizures still need urgent airway and neurologic treatment, not indefinite reliance on magnesium alone.

HELLP denotes hemolysis, elevated liver enzymes, and low platelets. Assess for bleeding, liver complications, renal injury, and TMA alternatives such as TTP or complement-mediated disease. Delivery and obstetric treatment decisions depend on the maternal-fetal situation; the neurocritical care role is stabilization and recognition of complications while that plan is developed.

PRES, RCVS, and Venous Thrombosis

Syndrome Common clue Important limitation

PRES Seizures, visual symptoms, encephalopathy, vasogenic edema Not always confined to posterior regions or completely reversible

RCVS Recurrent thunderclap headaches with segmental arterial narrowing Early vascular imaging can be normal; distinguish from vasculitis and SAH

CVT Headache, papilledema, seizures, hemorrhagic venous lesions Normal noncontrast CT does not exclude it

Treat blood pressure and seizures in PRES and address the trigger. In RCVS, review vasoactive exposures, recognize possible ischemic or hemorrhagic complications, and avoid assuming that every arterial narrowing requires corticosteroids for vasculitis. In CVT, pregnancy affects anticoagulant selection, but a hemorrhagic venous infarct does not automatically exclude anticoagulation.

Post-Organ-Transplant Encephalopathy

The outline also names post-transplant patients because immunosuppression changes both the infectious differential and drug handling. Evaluate the transplanted organ, time since transplant, induction and maintenance drugs, prophylaxis, recent rejection treatment, renal or hepatic function, and exposures. Fever and CSF inflammation may be muted. Infection, medication toxicity, stroke, seizures, graft dysfunction, and metabolic disturbance can coexist.

Calcineurin inhibitors such as tacrolimus or cyclosporine can be associated with tremor, encephalopathy, seizures, and PRES. A concentration in the nominal therapeutic range does not entirely exclude toxicity. Review interactions, including anti-infective drugs that alter metabolism, and assess blood pressure, magnesium, renal function, and the examination. Drug changes must be coordinated with the transplant team because abrupt unsupervised withdrawal can endanger the graft.

Host-Specific Infection and Vascular Risk

Opportunistic CNS infection depends on the immune defect and timing. Consider bacterial, viral, fungal, or parasitic causes based on host and exposure rather than applying one generic empirical regimen to every transplant recipient. MRI, blood studies, EEG, and CSF when safe can help; a negative initial study may not settle the diagnosis. Begin appropriate empirical therapy promptly when serious infection is plausible and reassess as results arrive.

Vascular events can result from embolism, coagulopathy, infection-related aneurysm, TMA, or ordinary vascular risk. A new focal deficit should activate a stroke and hemorrhage evaluation rather than be attributed automatically to immunosuppressant toxicity. When biopsy, lumbar puncture, or invasive monitoring is considered, assess hemostasis and procedural risks with the responsible specialists.

In a typical combined decision problem, a postpartum patient with seizures and severe hypertension needs immediate stabilization and an obstetric-neurologic assessment. A transplant recipient with similar MRI edema needs a different trigger search, including drug effects and infection. The imaging label PRES is a starting point for cause-directed care, not the complete diagnosis.

Sources checked October 17, 2026: ACOG preeclampsia guidance , ACOG magnesium teaching , and IDSA CNS infection guidance .