Neurologic clinics
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Chimeric antigen receptor-engineered T (CAR-T) cell immunotherapy has been successful in treating many types of hematological malignancies. CAR-T therapy, however, has been associated with toxicities, including cytokine release syndrome (CRS) as well as immune effector cell-associated neurotoxicity syndrome (ICANS). ⋯ ICANS pathophysiology likely is related to that of CRS. Preclinical studies and clinical experience have shed light on the driving forces of ICANS and have yielded new strategies to mitigate ICANS occurrence.
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Review
Imaging of Central Nervous System Tumors Based on the 2016 World Health Organization Classification.
The 2016 World Health Organization Classification of Tumors of the Central Nervous System (CNS) incorporated well-established molecular markers known to drive tumorigenesis and tumor behavior into the existing classification of CNS tumors based on histopathologic appearance. This integrated classification system has led to a major restructuring of the diffuse gliomas. In addition, it resulted in the categorization of medulloblastomas into four distinct molecular subgroups. Radiogenomic studies have revealed key imaging differences between certain genetic groups and may aid in the diagnosis, longitudinal assessment of treatment response, and evaluation of tumor recurrence in patients with brain tumors.
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Transcranial Doppler ultrasonography (TCD) is a noninvasive, bedside, portable tool for assessment of cerebral hemodynamics. Modern TCD head frames allow continuous hands-free emboli detection for risk stratification and assessment of treatment efficacy in several cardiovascular diseases. ⋯ The use of intraoperative TCD during carotid endarterectomy and stenting allows optimal intraoperative hemodynamic management. Other applications are also discussed.
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Migraine affects an estimated 12% of the population. Global estimates are higher. Chronic migraine (CM) affects 1% to 2% of the global population. ⋯ Migraine is associated with cardiovascular disease, psychiatric disease, and sleep disorders. It is the second most disabling condition worldwide. CM is associated with higher headache-related disability/impact, medical and psychiatric comorbidities, health care resource use, direct and indirect costs, lower socioeconomic status, and health-related quality of life.
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Diagnostic testing is of limited value among patients with migraine who present to an emergency department. Various nonopioid, disease-specific treatments are available for patients who present to an emergency department with migraine headache and associated features. Emergency physicians should recognize that the acute migraine presentation is part of an underlying disorder; care should be geared to the underlying headache disorder in addition to the acute attack.