Matthees, Nicholas

Introduction CAR T‐cell therapy is an immunotherapy essential in treating blood and plasma cancers. A common side effect of CAR T‐cell therapy is ICANS (Immune Effector Cell‐Associated Neurotoxicity Syndrome), with mechanism including excessive cytokine response resulting in endothelial dysfunction and blood brain barrier (BBB) disruption with CART cell migration to the CNS. Manifestations of ICANS includes aphasia, dysgraphia, tremor and other features of encephalopathy. PRES (posterior reversible encephalopathy syndrome) has a similar proposed mechanism of endothelial dysfunction and BBB breakdown while acute ischemic stroke can present similarly with aphasia. This is a case report of a patient who developed ICANS grade 3 found to have PRES on neuro imaging with initial improvement before again decompensating and found to have acute ischemic stroke. Methods N/A Results This was a 63‐year‐old female with multiple myeloma who underwent CAR T‐cell therapy. She developed encephalopathy and tremors consistent with grade 3 neurotoxicity with MR brain showing findings of mild PRES. She improved with ICANS treatment of steroids, Anakinra, tocilizumab, IT methotrexate/hydrocortisone and management of PRES with SBP control. Unfortunately, she had acute decompensation a week after these treatments with aphasia concerning for relapsed ICANS or PRES, however MR brain revealed a hyperacute left MCA stroke, not a candidate for treatment due to lack of LVO and thrombocytopenia. Subsequently she went into atrial fibrillation with RVR and was noted to have HfrEF. Repeat neuro imaging with CT head revealed multifocal strokes and R ICA occlusion. No obvious vasospasm on vessel imaging to support co‐existing RCVS given prior findings of PRES. Conclusion As CAR T‐cell therapy becomes widely utilized, it is important to be aware of the presentation of ICANS and remain diligent in ruling out ICAN mimics such as PRES and acute ischemic stroke. image image

Hippocampal segmentation is essential in neuroimaging for evaluating conditions like Alzheimer’s dementia and mesial temporal sclerosis, where small volume changes can significantly impact normative percentiles. However, inaccurate segmentation is common due to the inclusion of non-hippocampal structures such as choroid plexus and cerebrospinal fluid (CSF), leading to volumetric overestimation and confounding of functional analyses. Current methods of assessment largely rely on virtual or manual ground truth labels, which can fail to capture these inaccuracies. To address this shortcoming, this study introduces a more direct voxel intensity-based method of segmentation assessment. Using paired precontrast and postcontrast T1-weighted MRIs, hippocampal segmentations were refined by adding marginal gray matter and removing marginal CSF and enhancement to determine a total required correction volume. Six segmentation algorithms—e2dhipseg, HippMapp3r, hippodeep, AssemblyNet, FastSurfer, and QuickNat—were implemented and compared. HippMapp3r and e2dhipseg, followed closely by hippodeep, exhibited the least total correction volumes, indicating superior accuracy. Dedicated hippocampal segmentation algorithms outperformed whole-brain methods.

AbstractNerve plexuses are complex networks of interwoven nerves in the peripheral nervous system. This article provides a comprehensive overview of the anatomy and function of the major nerve plexuses in the human body. The main spinal nerve plexuses—cervical, brachial, abdominal, lumbar, and sacral—are examined in detail, including their spinal origins, anatomical locations, and the areas they innervate. Understanding the intricate anatomy of nerve plexuses is essential for interventionalists, as it aids in the diagnosis and treatment of various neurological disorders affecting the peripheral nervous system.