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We sought to review the evidence supporting neurocritical care as a distinct specialty of medicine.Over the past 20 years, neuro-intensive care units have evolved from neurosurgical units focused primarily on postoperative monitoring to units that provide comprehensive medical and specialized neurological support for patients with life-threatening neurological diseases. In addition to standard interventions, areas of expertise unique to neurocritical care include management of intracranial pressure, hemodynamic augmentation to improve cerebral blood flow, therapeutic hypothermia, and advanced neuromonitoring (i.e. continuous electroencephalography, brain-tissue oxygen, and microdialysis). Neurointensivists defragment care by focusing on the interplay between the brain and other systems, and by integrating all aspects of neurological and medical management into a single care plan. Outcomes research has established that victims of traumatic brain injury and hemorrhagic stroke experience reduced mortality, better functional outcomes, and reduced length of stay when cared for by neurointensivists in a dedicated neuro-intensive care unit. In the US a national system for accrediting training programs and certifying intensivists with special qualifications in neurocritical care is currently being established by the United Council of Neurologic Subspecialties.Neurocritical care is one of the newest subspecialties of medicine and is at the forefront of bringing effective new therapies to patients with life-threatening neurological diseases.