Neurocritical care as a subspecialty has grown rapidly over the last two decades and has reached a level of maturity with the advent of newer monitoring, diagnostic and therapeutic modalities in a variety of brain and spinal cord injury paradigms. This is clearly exhibited by the emerging newer fellowship training programs, the recently instituted subspecialty certification examination by the United Council for Neurologic Subspecialties and the increasing number of critical care units all over the world. These major strides in the subspecialty commensurate with the goals of "decade of the brain," coupled with the emerging data from clinical series and translational research, occasions another edition of this handbook.

The overarching goal of the handbook remains true to the first edition. The operative tenet remains that "time is brain", and rapid diagnosis and therapeutic interventions in these challenging patients cannot be overemphasized. The care provided to these subset of critically ill neurologic and neurosurgical patients continues to be multidisciplinary and includes care rendered from colleagues in Emergency Medical Services, emergency medicine, neurologists, neurosurgeons, anesthesiologists, critical care physicians, critical care nurses, nurse practitioners and physician assistants. The onus lies heavily on first-line physicians and other health care providers for early recognition, timely therapeutic interventions and referrals in patients experiencing acute neurological deterioration. The goal is for the Handbook to continue to serve as a quick reference guide for those involved in the care of critically ill neurological and neurosurgical patients and not meant to substitute for a full-length text. Based on feedback from the readership and colleagues, the first section of this edition covers general principles and logically progresses into the next section with specific problems encountered in neurocritical care. We have focused further on management algorithms from making and confirming the clinical diagnosis with appropriate ancillary radiologic and laboratory tests and management of acute neurological diseases. Tables and illustrations provide for quick and easy bedside reference for staff who are involved in the management of neurologically ill patients. Key points and references at the end of a chapter highlighting the essential elements should serve as a quick summary and salient features. We hope this second edition of the handbook fulfills its goal and will continue to provide a succinct and practical approach to the management of these critically ill neurological and neurosurgical patients.