Neurocritical care cases occupy a distinct analytical lane. The patients are severely ill, the clinical decisions compound rapidly, and the standard of care often rests on guidelines and practices specific to the neurocritical care subspecialty rather than on general critical care or general neurology. Post-cardiac-arrest care, neuroprognostication after coma, targeted temperature management, management of brain death, and the ICU-level treatment of stroke, subarachnoid hemorrhage, and status epilepticus each have their own literature and their own accepted standards. My review is grounded in seven years as a neurointensivist and former Medical Director of a Neuroscience ICU at an academic center, in current clinical practice at a comprehensive stroke and trauma center, and in the governing guidelines (AHA, NCS, ERC-ESICM, ACNS).
Scope
Neurocritical care engagements cover the full range of ICU-level neurological conditions, with emphasis on the decisions that are specific to this subspecialty rather than to general critical care.
- Post-cardiac-arrest care and hypoxic-ischemic brain injury — targeted temperature management, hemodynamic optimization, post-arrest neurological monitoring, and the timing of escalation or de-escalation of care.
- Neuroprognostication after cardiac arrest or coma — the multimodal framework (clinical examination, EEG, somatosensory evoked potentials, biomarkers, neuroimaging), the timing of prognostic determinations, the self-fulfilling-prophecy problem that shapes much of the litigation in this area, and withdrawal-of-care decisions.
- Brain death determination — examination standards, ancillary testing when indicated, and the procedural integrity that brain death declarations require.
- Status epilepticus — recognition, first- and second-line management, refractory and super-refractory trajectories, and the critical-care considerations that shape outcomes.
- ICU-level management of intracerebral and subarachnoid hemorrhage — including the post-SAH complications (vasospasm, delayed cerebral ischemia, hydrocephalus) that make SAH an ongoing rather than one-time event.
- Complex ICU-related neurological syndromes — ICU-acquired weakness, posterior reversible encephalopathy syndrome, critical illness encephalopathy, and related conditions where the differential is both neurocritical and systemic.
I am an ABIME-certified Independent Medical Examiner and hold dual board certification in neurocritical care (ABPN and UCNS). The dual neurocritical care credential is uncommon and is relevant where the analytical standard is neurocritical-care-specific rather than general critical care.
Engagement
Neurocritical care cases often involve complex timelines, multiple specialist handoffs, and decisions made under time pressure.
- Pre-retention case consultation — a structured early conversation before formal engagement.
- Records review with written analysis — structured review and written analytical summary.
- Independent medical examination (IME) — in-person or video examination, conducted under ABIME standards, with a structured written report.
- Expert report — formal written expert report suitable for disclosure.
- Deposition and trial testimony — testimony consistent with the written record.
I review for plaintiff and defense counsel on an independent basis. I decline cases outside my clinical domain, cases where the record will not support the opinion sought, and cases where my schedule will not permit the attention the work requires.
Related Writings
Writings on neurocritical care, for counsel wanting to see how I reason about these cases before engaging.
- Hypoxic-Ischemic Brain Injury: When the Fight Is About Timing — Commentary on HIBI, post-arrest care, TTM2, and the self-fulfilling-prophecy problem in neuroprognostication.
- Missed Subarachnoid Hemorrhage: The Case That Turns on the History — Commentary on SAH recognition and the downstream neurocritical care that follows.
- Neuroimaging in Litigation: What It Shows, What It Does Not Prove — Primer on what CT, MRI, and advanced imaging can and cannot support, including in ICU contexts.