Preface

A lot has happened since the first edition of this book and my departure from New York City to arrive in Houston, Texas. The field of neurology continued to evolve, especially in the area of therapeutics. Multiple class I-type of evidence emerged from intraarterial thrombectomy studies showing its undeniable, outcome-improving intervention, when combined with intravenous rt-PA compared to intravenous thrombolysis alone in 2015. This ground-breaking study result, along with other therapeutic advances in other neurological subspecialties, further transformed the field of neurology from merely admiring phenomenology to more time-sensitive interventional field. The field of neurocritical care is at the forefront of therapeutic efforts, as our daily practice focuses on resuscitating and reversing multiple organ failures.

The idea of neurologic critical care is to provide acute medical therapies and appropriate interventions promptly by constantly monitoring the patients in one area by specially trained physicians and nurses. Injured brains do not wait for consults to show up and have a low threshold for irreversible damages. “Time is brain” in many situations, and it is of paramount importance that neurocritical care team must physically staff the unit 24/7 and act quickly in the event of neuro-emergencies. Patients with acute, severe brain injuries are often accompanied by other organ failures at the time of initial presentation or during the ICU stay. Therefore, neurointensivists must be trained to handle not only the brain, but also rest of the body. This textbook is written for that very reason. Readers will once again find this textbook being not just about the brain and spine. It is about all organ insufficiencies and failures along with neurologic illnesses. After the success and popularity of the first edition, the second edition again emphasizes and focuses on one principle: practicality. This book is easy to read and full of real cases that one may encounter in a neurocritical care unit. The flow of content is in the form of dialogue. You will feel like you are making rounds with me. By discussing and focusing on multiple challenging problems, and by paying attention to all organs rather just the brain, it is my hope that you would find this textbook extremely helpful for both daily practices as well as for board examinations.