Acute Neurological Complications of Brain Tumors and Immune Therapies, a Guideline for the Neuro-hospitalist

Abstract

Purpose of Review

Patients with brain tumors presenting to the emergency room with acute neurologic complications may warrant urgent investigations and emergent management. As the neuro-hospitalist will likely encounter this complex patient population, an understanding of the acute neurologic issues will have value.

Recent Findings

We discuss updated information and management regarding various acute neurologic complications among neuro-oncology patients and neurologic complications of immunotherapy.

Summary

Understanding of the acute neurologic complications associated with central nervous system tumors and with common contemporary cancer treatments will facilitate the neuro-hospitalist management of these patient populations. While there are aspects analogous to the diagnosis and management in the non-oncologic population, a number of unique features discussed in this review should be considered.

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Abbreviations

CNS:

Central nervous system

RT:

Radiation therapy

SMART:

Stroke-like migraine attacks after radiation therapy

ICH:

Intracerebral hemorrhage

mRS:

Modified Rankin score

AHA:

(American Heart Association)/ASA (American Stroke Association)

DOACs:

Direct oral anticoagulants

LMWH:

Low molecular weight heparin

VEGF:

Vascular endothelial growth factor

PANWARDS:

Platelets, albumin, no congestive heart failure, warfarin, age, race, diastolic blood pressure, stroke

mTOR:

Mechanistic target of rapamycin

MAPK:

Mitogen-activated protein kinases

DNET:

Dysembryoplastic neuroepithelial tumors

IDH:

Isocitrate dehydrogenase

LEATs:

Long-term epilepsy-associated tumors

D2HG:

2-Hydroxyglutarate

MDR1:

Multidrug resistance gene

ICP:

Intracranial pressure

CSF:

Cerebrospinal fluid

BBB:

Blood-brain barrier

MRI:

Magnetic resonance imaging

PRES:

Posterior reversible encephalopathy syndrome

PNS:

Peripheral nervous system

ICI:

Immune checkpoint inhibitors

CAR:

Chimeric antigen receptor

PD-1:

Programmed death1

PD-L1:

Programmed death ligand 1

CTLA4:

Cytotoxic T lymphocyte-associated protein 4

AE:

Adverse events

CRS:

Cytokine release syndrome

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Conception/design: Jigisha Thakkar, Rimas Lukas

Collection and/or assembly of data: Jigisha Thakkar, Rimas Lukas

Data analysis and interpretation: Jigisha Thakkar, Rimas Lukas

Manuscript writing and editing: Jigisha Thakkar, Rimas Lukas, Vikram Prabhu

Table creation: Jigisha Thakkar, Rimas Lukas

Final approval of manuscript: Jigisha Thakkar, Rimas Lukas, Vikram Prabhu, Stasia Rouse

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Correspondence to Jigisha P. Thakkar.

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Jigisha Thakkar: No conflict of interest

Vikram Prabhu: No conflict of interest

Stasia Rouse: No conflict of interest

Rimas Lukas: BMS research support (drug only), Novocure Speakers bureau and advisory board, Honoraria for medical editing for Medlink Neurology and EBSCO. Received funding from P50CA221747

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Thakkar, J.P., Prabhu, V.C., Rouse, S. et al. Acute Neurological Complications of Brain Tumors and Immune Therapies, a Guideline for the Neuro-hospitalist. Curr Neurol Neurosci Rep 20, 32 (2020). https://doi.org/10.1007/s11910-020-01056-0

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Keywords

  • Neurotoxicity
  • Brain tumors
  • Immunotherapies
  • Brain metastases
  • CART-T cell
  • Neurologic complications