[Critical care neurology--present and future directions]

In Japan, we have first alerted the necessity of critical care neurology (CCN) and neuro-ICU in 2000, however, CCN is still unrecognized. In the United States and Germany, CCN has become recognized as one of the important subspecialty in neurology, and also, there is progressive increase of neuro-intensive care unit (neuro-ICU) after 1990s. In this symposium, the present status, problems, and future direction of clinical study and practice in CCN were reviewed from the standpoints as follows; 1 Quantitative and sequential analysis of literatures in CCN: MEDLINE search disclosed marked increase in CCN-related literatures since 1990s. 2 Categorical analysis of important literatures selected by German Society of CCN. 3 Analysis of clinical practice in CCN through neuro-ICU simulation study: in 442 inpatients who admitted to our department during 1998. 4 Analysis of requisites in critical care in neurology practice both in diagnostic and therapeutic aspects. 5 Historical development of CCN. 6 Evaluation of the effect of neuro-ICU. 7 Short-term and long-term problems for the activation of CCN. In conclusion, 1) CCN is still immature in Japan, and needs early establishment, including neuro-ICU and educational system for developing neurointensivist, 2) Extraction of problems, decision-making, and rapid differential diagnosis are critical to prevent and manage life-threatening neurological conditions.