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Patients admitted to the intensive care unit (ICU) with critical illness or injury are at risk for neurologic complications.1–5 A sudden or unexpected change in the neurologic condition of a critically ill patient often heralds a complication that may cause direct injury to the central nervous system (CNS). Alternatively, such changes may simply be neurologic manifestations of the underlying critical illness or treatment that necessitated ICU admission (e.g., sepsis). These complications can occur in patients admitted to the ICU without neurologic disease and in those admitted for management of primary CNS problems (e.g., stroke). Neurologic complications can also occur as a result of invasive procedures and therapeutic interventions. Commonly, recognition of neurologic complications is delayed or missed entirely because therapeutic interventions such as intubation and sedatives interfere with the physical examination or otherwise confound the clinical picture. In other cases, neurologic complications are not recognized because of a lack of sensitive methods to detect the problem (e.g., delirium). Morbidity and mortality are increased among patients who develop neurologic complications; therefore the intensivist must be vigilant in evaluating all critically ill patients for changes in neurologic status.