Citations

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

The Neurohospitalist Core Competencies comprise a set of competency-based learning objectives that encapsulate the knowledge, skills, and attitudes of neurohospitalitists who specialize in the care of hospitalized patients with neurologic conditions. These competencies serve to characterize the rapidly expanding field of neurohospitalist medicine. The 27 chapters are divided into 3 sections entitled: neurological conditions, clinical interventions and interpretation of ancillary studies, and neurohospitalist role in the healthcare system. Each individual learning objective in the chapters describes a specific concept with an action verb to illustrate the behavior that the neurohospitalist exhibits. The individual neurohospitalist may not exhibit mastery in each of the topics included as individual practices vary in scope and practice pattern. A few examples of how the complete set of competencies may be used include in the creation of curricula for neurohospitalist fellowships, to assist in defining the scope of practice of neurohospitalists for administrative leaders of hospitals and departments, and in influencing the direction of further research and quality improvement in the field.