Purpose of review <p>Delirium is highly prevalent after acute brain injury and is associated with poor outcomes, yet neurocritically ill patients remain underrepresented in delirium research. This review examines recent evidence and current challenges in delirium detection, prevention, and treatment in patients with acute neurological injury.</p> Recent findings <p>Commonly used ICU delirium screening tools such as the CAM-ICU and ICDSC demonstrate reduced accuracy in patients with severe neurological deficits, while newer tools like the FMSE show promise in neurocritically ill populations. Multicomponent non-pharmacologic interventions remain central to delirium management, while pharmacological strategies have been aimed at minimizing risks, as clinical trials of most pharmacological delirium treatments have largely shown no benefit. However, data specific to neurocritical care settings remain limited.</p> Summary <p>Delirium management in ICU patients with acute brain injury is often adapted from other patient populations, though there have been recent efforts to harmonize delirium assessment methods in neurocritical care settings. With the increasing awareness of delirium and its clinical implications in patients with acute brain injury, more studies are needed to develop preventive and therapeutic approaches tailored to this highly vulnerable patient population.</p>