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Leptomeningeal disease

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https://www.readbyqxmd.com/read/29345149/medical-management-of-brain-metastases-and-leptomeningeal-disease-in-patients-with-breast-carcinoma
#1
Kelsey M Bowman, Priya Kumthekar
Breast cancer is the most common malignancy among women and accounts for the second highest number of cancer-related deaths. With patients surviving longer due to advances in systemic control, the incidence of CNS involvement is increasing; however, the management of CNS metastases has not undergone parallel advancements. The blood-brain barrier limits the efficacy of most systemic chemotherapies, and the utilization of surgery and radiation beyond first-line therapy is limited. We will explore the recent developments in the medical management of breast cancer brain metastasis...
January 18, 2018: Future Oncology
https://www.readbyqxmd.com/read/29284603/cerebrovascular-manifestations-of-neurosarcoidosis-an-underrecognized-aspect-of-the-imaging-spectrum
#2
REVIEW
G Bathla, P Watal, S Gupta, P Nagpal, S Mohan, T Moritani
Involvement of the central nervous system by sarcoidosis, also referred to as neurosarcoidosis, is seen clinically in about 5% of patients with systemic disease. CNS involvement most frequently affects the leptomeninges and cranial nerves, though the ventricular system, brain parenchyma, and pachymeninges may also be involved. Even though the involvement of the intracranial vascular structures is well-known on postmortem studies, there is scant literature on imaging manifestations secondary to the vessel wall involvement, being confined mostly to isolated case reports and small series...
December 28, 2017: AJNR. American Journal of Neuroradiology
https://www.readbyqxmd.com/read/29277461/intra-cranial-granulomatous-disease-in-common-variable-immunodeficiency-case-series-and-review-of-the-literature
#3
REVIEW
Catherine E Najem, Jason Springer, Richard Prayson, Daniel A Culver, James Fernandez, Jinny Tavee, Rula A Hajj-Ali
BACKGROUND/PURPOSE: Common variable immunodeficiency (CVID) is typically characterized by hypogammaglobulinemia and often but not always recurrent infections. Paradoxically, 8-22% of patients with CVID develop granulomatous disease. Granulomata have been described in many organs including the lungs, skin, liver, spleen, kidneys, eyes, lymph nodes, and intestines. Data about central nervous system (CNS) involvement in CVID are extremely rare. We aim to describe a case series and include an extensive literature review of CNS involvement in CVID to understand the different features and patterns of the disease...
October 20, 2017: Seminars in Arthritis and Rheumatism
https://www.readbyqxmd.com/read/29273521/the-pathology-and-pathophysiology-of-vascular-dementia
#4
REVIEW
Raj N Kalaria
Vascular dementia (VaD) is widely recognised as the second most common type of dementia. Consensus and accurate diagnosis of clinically suspected VaD relies on wide-ranging clinical, neuropsychological and neuroimaging measures in life but more importantly pathological confirmation. Factors defining subtypes of VaD include the nature and extent of vascular pathologies, degree of involvement of extra and intracranial vessels and the anatomical location of tissue changes as well as time after the initial vascular event...
December 19, 2017: Neuropharmacology
https://www.readbyqxmd.com/read/29250697/two-girl-patients-with-medulloblastoma-case-reports
#5
Laura Daniela Marinău, Cristina Elena Singer, Cristian Meşină, Elena Carmen Niculescu, Ileana Puiu, Ileana Octavia Petrescu, Cristiana Geormăneanu, Augustina Cornelia Enculescu, Daniela Elise Tache, Ştefana Oana Purcaru, Simona Răciulă, Cosmina Lucia Damian
In childhood, the most common type of brain tumors is medulloblastoma, a highly malignant primary brain tumor that is found in the cerebellum or posterior fossa. The tumor mass increases and generates obstructive hydrocephalus. Risk factors (that might be involved in some cases) include the genetic syndrome such as type 1 neurofibromatosis, exposure to ionizing radiation and Epstein-Barr virus. Medulloblastoma is associated with recessively inherited Turcot disease and with conditions as ataxia-telangiectasia syndrome in several cases...
2017: Romanian Journal of Morphology and Embryology, Revue Roumaine de Morphologie et Embryologie
https://www.readbyqxmd.com/read/29248376/postoperative-radiosurgery-for-the-treatment-of-metastatic-brain-tumor-evaluation-of-local-failure-and-leptomeningeal-disease
#6
Paul M Foreman, Bradford E Jackson, Karan P Singh, Andrew K Romeo, Barton L Guthrie, Winfield S Fisher, Kristen O Riley, James M Markert, Christopher D Willey, Markus Bredel, John B Fiveash
In patients undergoing surgical resection of a metastatic brain tumor, whole brain radiation therapy reduces the risk of recurrence and neurologic death. Focal radiation has the potential to mitigate neurocognitive side effects. We present an institutional experience of postoperative radiosurgery for the treatment of brain metastases. A retrospective review of a prospectively maintained institutional radiosurgery database was performed for the years 2005-2015 identifying all adult patients treated with postoperative radiosurgery to the tumor bed...
December 13, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/29243979/a-multi-institutional-analysis-of-the-untreated-course-of-cerebral-dural-arteriovenous-fistulas
#7
Bradley A Gross, Felipe C Albuquerque, Cameron G McDougall, Brian T Jankowitz, Ashutosh P Jadhav, Tudor G Jovin, Rose Du
OBJECTIVE The rarity of cerebral dural arteriovenous fistulas (dAVFs) has precluded analysis of their natural history across large cohorts. Investigators from a considerable proportion of the few reports that do exist have evaluated heterogeneous groups of untreated and partially treated lesions. In the present study, the authors exclusively evaluated the untreated course of dAVFs across a multi-institutional data set to delineate demographic, angiographic, and natural history data. METHODS A multi-institutional database of dAVFs was queried for demographic and angiographic data as well as untreated disease course...
December 15, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/29242055/late-disseminated-lyme-disease-associated-pathology-and-spirochete-persistence-post-treatment-in-rhesus-macaques
#8
Nicholas A Crossland, Xavier Alvarez, Monica E Embers
Non-human primates currently serve as the best experimental model for Lyme disease due to their close genetic homology with humans and demonstration of all three phases of disease following infection with Borreliella (Borrelia) burgdorferi (Bb). We investigated the pathology associated with late disseminated Lyme disease (12 to 13 months following tick inoculation) in doxycycline-treated (28 days; 5mg/kg, oral, 2x/day) and untreated rhesus macaques (Rm). Minimal to moderate lymphoplasmacytic inflammation, with a predilection for perivascular spaces and collagenous tissues, was observed in multiple tissues including the cerebral leptomeninges, brainstem, peripheral nerves from both fore and hind limbs, stifle synovium and perisynovial adipose tissue, urinary bladder, skeletal muscle, myocardium, and visceral pericardium...
December 11, 2017: American Journal of Pathology
https://www.readbyqxmd.com/read/29230121/leptomeningeal-disease-and-the-evolving-role-of-molecular-targeted-therapy-and-immunotherapy
#9
REVIEW
Katharine Hall Thomas, Robert A Ramirez
Background: Leptomeningeal disease (LMD) is a complication that results from solid tumor metastasis. Prognosis is extremely poor. As therapeutic options for solid tumors improve, the rate of LMD continues to increase. Until recently, treatment has been limited to radiation therapy, intrathecal chemotherapy, and systemic chemotherapy, with an overall survival of 2-3 months. Targeted molecular therapy and immunotherapies are promising new options for increasing overall survival and clinical improvement; however, optimal clinical management remains unknown...
2017: Ochsner Journal
https://www.readbyqxmd.com/read/29221687/leptomeningeal-carcinomatosis-in-colorectal-cancer-the-mayo-clinic-experience
#10
Gretchen Taylor, Nina Karlin, Thorvardur R Halfdanarson, Kyle Coppola, Axel Grothey
BACKGROUND: Leptomeningeal metastasis (LM) is an uncommon form of metastatic disease in many cancers. There remains a paucity of literature with regard to the course and management of LM in colorectal cancers (CRCs). The aim of this study was to estimate the incidence of LM in patients with CRC seen at our institution over a 15-year period, and to describe the clinical course and outcome of these cases. METHODS: LM in CRC primary cases between 2000 and 2014 were identified in the Mayo Clinic databases...
November 21, 2017: Clinical Colorectal Cancer
https://www.readbyqxmd.com/read/29200113/primary-central-nervous-system-lymphoma
#11
Catherine H Han, Tracy T Batchelor
PURPOSE OF REVIEW: Primary central nervous system (CNS) lymphoma is a rare and aggressive extranodal non-Hodgkin lymphoma confined to the brain, eyes, spinal cord, or leptomeninges without systemic involvement. This article provides an overview of the clinical features, diagnosis, and management of primary CNS lymphoma in patients who are immunocompetent, focusing on recent advances in treatment. RECENT FINDINGS: Primary CNS lymphoma is sensitive to radiation therapy; however, whole-brain radiation therapy inadequately controls the disease when used alone and causes delayed neurotoxicity with significant neurocognitive impairment, especially in patients who are elderly...
December 2017: Continuum: Lifelong Learning in Neurology
https://www.readbyqxmd.com/read/29200112/epidemiology-treatment-and-complications-of-central-nervous-system-metastases
#12
Amy A Pruitt
PURPOSE OF REVIEW: Neurologic problems resulting from systemic cancer metastases to brain parenchyma, dura, spinal cord, and leptomeninges are among the most common types of consultations addressed by neurologists. With patients surviving longer from systemic cancer, along with the rapidly evolving therapeutic options, the treatment of these devastating complications has become both more effective and more complicated. This article reviews current patterns of metastatic disease and the increasingly nuanced landscape of evolving therapies, their complications, and their impact on quality of survival...
December 2017: Continuum: Lifelong Learning in Neurology
https://www.readbyqxmd.com/read/29190637/standard-dose-osimertinib-for-refractory-leptomeningeal-metastases-in-t790m-positive-egfr-mutant-non-small-cell-lung-cancer
#13
Shigeki Nanjo, Akito Hata, Chiyuki Okuda, Reiko Kaji, Hideaki Okada, Daisuke Tamura, Kei Irie, Hiroshi Okada, Shoji Fukushima, Nobuyuki Katakami
BACKGROUND: Osimertinib demonstrated promising efficacy for refractory leptomeningeal metastases (LM) in preclinical data and a clinical study at 160 mg, but there is limited data for the standard 80 mg dose. METHODS: T790M-positive patients with suspected LM after classical epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) failure were enroled. RESULTS: We investigated 13 patients (5 definitive and 8 possible LM cases)...
November 30, 2017: British Journal of Cancer
https://www.readbyqxmd.com/read/29177676/extracranial-extra-cns-spread-of-embryonal-tumor-with-multilayered-rosettes-etmr-case-series-and-systematic-review
#14
Ashish H Shah, Ziad Khatib, Toba Niazi
BACKGROUND: Embryonal tumors with multilayered rosettes (ETMR) is a rare variant of embryonal tumor of infancy with nearly 200 cases reported in the literature. Leptomeningeal spread of this tumor is well known; however, extracranial metastasis has been sparsely reported in the literature. METHODS: Our study was divided into two sections: (1) We conducted a retrospective review of our patient series of ETMR and screened for patients with evidence of ETMR over the last 10 years 2007-2017 at a single tertiary referral pediatric hospital, and (2) we conducted a systematic review according to PRISMA guidelines of all reported cases of ETMR to determine the incidence of extracranial metastasis and treatment paradigms...
November 25, 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/29173769/durable-response-to-osimertinib-in-egfr-mutated-t790m-wildtype-non-small-cell-lung-cancer-with-leptomeningeal-metastases-a-case-report
#15
Anna Chalmers, Leif Jensen, Wallace Akerley
In patients with non-small cell lung cancer (NSCLC) progression with leptomeningeal (LM) metastases is a catastrophic event with limited treatment options. We report a patient who developed leptomeningeal disease while on front-line erlotinib. High-dose tyrosine kinase inhibitor was started but ineffective. She was transitioned to third-generation TKI osimertinib, despite lacking a T790M mutation, and responded with complete resolution of symptoms and malignant cytology in the cerebrospinal fluid (CSF). Recent phase one data and our case indicate osimertinib should be viewed as a best practice for treatment of LM disease in epidermal growth factor receptor (EGFR) mutated NSCLC regardless of T790M status...
December 2017: Lung Cancer: Journal of the International Association for the Study of Lung Cancer
https://www.readbyqxmd.com/read/29171118/translesional-pressure-gradient-and-leptomeningeal-collateral-status-in-symptomatic-middle-cerebral-artery-stenosis
#16
Xinyi Leng, Linfang Lan, Hing Lung Ip, Florence Fan, Sze Ho Ma, Karen Ma, Haipeng Liu, Zhengzheng Yan, Jia Liu, Jill Abrigo, Yannie Oy Soo, David S Liebeskind, Ka Sing Wong, Thomas W Leung
BACKGROUND AND PURPOSE: Leptomeningeal collateral (LMC) status governs prognosis of large artery occlusive stroke, while factors determining the LMC status were not fully elucidated. We aimed to investigate metrics affecting LMC status in such patients by using computational fluid dynamics (CFD) models based on CT angiography (CTA). METHODS: In this cross-sectional study, we recruited patients with recent ischemic stroke or transient ischemic attack attributed to atherosclerotic M1 middle cerebral artery (MCA) stenosis (50-99%)...
November 24, 2017: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/29170908/local-control-and-overall-survival-for-adjuvant-stereotactic-radiosurgery-in-patients-with-residual-or-recurrent-disease
#17
Tavish Nanda, Andrew Yaeh, Cheng-Chia Wu, Ashish Jani, Shumaila Saad, Yasir H Qureshi, Keith A Cauley, Jeraldine Lesser, Simon K Cheng, Steven R Isaacson, Michael B Sisti, Jeffrey N Bruce, Guy M McKhann, Sameer A Sheth, Andrew B Lassman, Tony J C Wang
Prior studies of post-operative stereotactic radiosurgery (SRS) have not distinguished between Adjuvant SRS (ARS) versus Adjuvant SRS to residual/recurrent disease (ARD). In this study, we defined ARS and ARD and investigated local control (LC), overall survival (OS), distant development of brain metastases (DBF), and leptomeningeal disease (LMD). We retrospectively identified BM patients who received surgical resection and SRS for BM from an IRB approved database between Jan 2009-Aug 2015. Patients were stratified into two groups: ARS and ARD...
November 23, 2017: Journal of Neuro-oncology
https://www.readbyqxmd.com/read/29166635/the-protean-neuropsychiatric-and-vestibuloauditory-manifestations-of-neurosarcoidosis
#18
Jacqueline J Greene, Ilka C Naumann, Janet M Poulik, Kevin T Nella, Lindsay Weberling, Jeffrey P Harris, Akihiro J Matsuoka
BACKGROUND: A rare subset of sarcoidosis, neurosarcoidosis, is reported to occur in 5-7% of sarcoid patients and can manifest in a variety of ways. The most common are facial paralysis and optic neuritis, less commonly causing cochleovestibulopathy, blindness, anosmia, and other cranial nerve (CN) palsies. The sensory deficit may be severe and psychiatric symptoms may result from the effects of the disease or steroid treatment. Although MRI-compatible cochlear implants are now available, concerns about the feasibility of recoverable hearing with cochlear implantation in these patients as well as the practical difficulty of disease monitoring due to implant artifact must be considered...
November 23, 2017: Audiology & Neuro-otology
https://www.readbyqxmd.com/read/29165794/leptomeningeal-metastasis-from-systemic-cancer-review-and-update-on-management
#19
REVIEW
Nancy Wang, Mia S Bertalan, Priscilla K Brastianos
Leptomeningeal metastasis is an uncommon and typically late complication of cancer with a poor prognosis and limited treatment options. Diagnosis is often challenging, with nonspecific presenting symptoms ranging from headache and confusion to focal neurologic deficits, such as cranial nerve palsies. Standard diagnostic evaluation involves a neurologic examination, magnetic resonance imaging of the brain and spine with gadolinium, and cytologic evaluation of the cerebral spinal fluid. Therapy entails a multimodal approach focused on palliation with surgery, radiation, and/or chemotherapy, which may be administered systemically or directly into the cerebral spinal fluid...
November 22, 2017: Cancer
https://www.readbyqxmd.com/read/29145292/recurrent-spinal-primitive-neuroectodermal-tumor-with-brain-and-bone-metastases-a-case-report
#20
Frank Chen, Shyh-Shin Chiou, Sheng-Fung Lin, Ann-Shung Lieu, Yi-Ting Chen, Chih-Jen Huang
RATIONALE: Primary spinal primitive neuroectodermal tumor (PNET) is relatively rare in all age groups, and the prognosis in most cases of spinal PNETs appears to be poor, with a median patient survival of 1 to 2 years. We present a case with recurrent spinal PNET with brain and bone metastases that was successfully treated by multimodality treatment. PATIENT CONCERNS: A 14-year-old teenage girl had suffered from progressive left upper back pain with bilateral lower legs weakness and numbness for 1 year...
November 2017: Medicine (Baltimore)
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