Introduction

It is a pleasure to guest edit this supplement for the Journal of Pharmacy Practice on contemporary topics in neurologic critical care. The specialty of neurocritical care is a relatively new and expanding area of medicine focusing on the comprehensive care of critically ill patients with primary or secondary neurologic problems. While these patients have been managed traditionally in a variety of different intensive care units (ICUs) including neurosurgical, medical, and surgical ICUs, it has been recognized that patients’ outcomes are better when they are cared for in specialty neurointensive care units managed by specialty-trained neurointensivists. A specialized multidisciplinary neurocritical care team can integrate all aspects of neurological and medical management into a single care plan. There has been an increasing role for pharmacists on these multidisclipinary teams to provide optimal pharmaceutical care to patients with acute neurologic injuries. However, it requires knowledge and mastery of the disorders that frequently occur in these patients. This issue encompasses a wide range of therapeutic areas that are commonly seen in the neurocritical care unit (NCCU) to assist pharmacists in their decision-making processes related to drug therapy. The contributors to this issue are all members of the Neurocritical Care Society that is a ‘‘rapidly growing international organization composed of multiprofessional healthcare providers that are dedicated to improve the care and outcomes of patients with life-threatening neurological illnesses by promoting quality patient care, professional collaboration, research, training and advocacy’’ (www.neurocriticalcare.org, accessed February 17, 2010). Stroke is the third leading cause of death and leading cause of adult disability in the United States. There are two main types of stroke including ischemic and hemorrhagic (intracerebral hemorrhage and subarachnoid hemorrhage). Over the past 20 years, there has been significant developments in our understanding and advancement in the treatment of all types of acute stroke, subsequently guidelines from the American Heart Association/American Stroke Association have all been updated within the last 3 years. Drs Baldwin and McCoy review the clinical evidence for the management of acute ischemic stroke, the most common type of stroke. Dr Parker addresses optimal management of spontaneous intracerebral hemorrhage including anticoagulant-associated intracerebral hemorrhage. An article authored by Drs McAllen, Liu-DeRyke, and myself reviews the clinical evidence available for the management of aneurysmal subarachnoid hemorrhage. Each article highlights the currently published treatment guidelines. Traumatic brain injury (TBI) is a major cause of morbidity, mortality, and economic cost to our society. The injuries sustained following TBI can be classified as primary or secondary injury. Primary injury is related to the mechanical forces at the time of trauma and there is very little intervention that can reverse the consequences of this type of injury. However, secondary injury occurs minutes to days after the primary injury and is a result of a series of physiologic and biochemical alterations that lead to further neuronal damage. The focus of care following TBI is on the prevention and/or minimization of secondary injury. Studies have shown improved outcomes and reduced mortality using an evidence-based protocol focusing on maintaining adequate cerebral perfusion. The Brain Trauma Foundation maintains and revises guidelines for the management of TBI and these guidelines will be addressed by Drs Gross, Norman, and Cook as they provide a comprehensive review of TBI management. Seizures and the risk of seizures are common in the NCCU. Many patients with acute brain injuries/diseases are at increased risk for development of seizures, thus seizure prophylaxis may be commonly administered. However, the use of anticonvulsants is not without risk and the introduction of the second generation of anticonvulsants has added to the complexity of treatment decision making. Recent data suggest that the use of the older anticonvulsants in prophylaxis regimens may have a negative impact on cognitive recovery. Additionally, the optimal management of status epilepticus is largely unknown and has lead to a variety of prescribing practices across the United States. Drs Tesoro and Brophy provide a discussion of status epilpeticus and acute seizure management along with the most up-to-date data on seizure prophylaxis. The use of sedation and analgesia in the NCCU is an essential piece of daily therapeutic management. The maintenance of cerebral perfusion is a fundamental objective of care and the