HOT TOPICS: Neuroprognostication in Acute Ischemic Stroke

In this episode of the NCS Podcast Hot Topics series, host Rich Choi, MD, is joined by Alejandro Rabinstein, MD, Shraddha Mainali, MD, and Krishna Rajajee, MD, to discuss the article "Guidelines for Neuroprognostication in Critically Ill Adults With Acute Ischemic Stroke," published in Neurocritical Care. Their conversation explores the development of the guideline, including the need for a more structured, evidence-based approach to prognostication in critically ill patients with acute ischemic stroke. The guests discuss why early prognostication is especially high-stakes, how uncertainty and the risk of self-fulfilling prophecy shaped the recommendations and why no single clinical variable or prediction model is reliable enough to guide individual decisions about poor outcomes. They also review the role of early neurological improvement as a moderately reliable predictor of good outcomes, the limitations of existing prediction models in the era of reperfusion therapy, and the importance of multimodal assessment, ongoing family conversations, long-term outcome counseling and shared decision-making rooted in each patient's values. The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.