作为CAR-T神经毒性表现的渐进性多重头骨神经病变
Zachary T Lazzari1, Avi Singh Gandh1, Bhagya Sannananja2
1Department of Neurology, School of Medicine, Emory University, Atlanta, GA, USA.
The Neurohospitalist
|October 28, 2025
概括
对多发性骨髓瘤的化学抗原受体T细胞 (CAR-T) 治疗可以引起延迟的神经毒性,呈现为渐进的多发性神经病变. 这一案例突出了一个用皮质类固醇和康复治疗改善的患者.
科学领域:
- 神经科学是一个神经科学.
- 免疫学 免疫学 免疫学
- 在瘤学瘤学.
背景情况:
- 化学抗原受体T细胞 (CAR-T) 治疗是一种治疗多发性骨髓瘤的新疗法.
- 免疫效应细胞相关神经毒性综合征 (ICANS) 是CAR-T疗法的已知并发症,通常表现为脑病变和发作.
- 作为CAR-T神经毒性表现的渐进性多重神经病变并未得到充分描述.
研究的目的:
- 在CAR-T治疗后报告延迟发病的多重神经病变的病例.
- 讨论这种罕见的神经毒性的临床表现,诊断结果和治疗.
- 要强调的是,CAR-T神经毒性可以呈现出渐进的头骨神经参与.
主要方法:
- 一个75岁的男性因多发性骨髓瘤而接受CAR-T治疗的病例报告.
- 详细描述患者的神经症状,包括面部神经麻和头骨神经VI参与.
- 利用对比的大脑MRI,血清和脑脊液 (CSF) 测试进行诊断.
- 对包括皮质类固醇和面部康复在内的治疗有记录的反应.
主要成果:
- 患者在CAR-T后19天出现左脸神经麻,在31日发展为双边脸神经麻和左头骨神经VI麻.
- 磁力共振成像显示双边面部神经的增强;CSF和血清测试没有显著的.
- 最初的口服类固醇治疗是无效的;高剂量的静脉注射类固醇,然后是普雷迪尼松逐渐减少,导致CN VI麻的解决和面部麻的中度改善.
结论:
- 卡尔-T疗法可以诱导延迟的神经毒性,表现为渐进的多重神经病变.
- 这种情况的最佳治疗方法尚不清楚.
- 皮质类固醇和长期康复可能会导致这些罕见病例的改善.
相关概念视频
01:15Parkinson's Disease: Overview
1.7K
Neurodegenerative disorders are progressive diseases that cause irreversible damage and loss to neurons in specific brain areas. Examples of these disorders include Parkinson's disease, Alzheimer's disease, Multiple Sclerosis (MS), and Amyotrophic Lateral Sclerosis (ALS). These disorders share characteristics such as proteinopathies, selective neuronal vulnerability, and a complex interplay between genetic and environmental factors. The primary therapeutic goal for these conditions is...
1.7K
01:24Chronic Kidney Disease II: Clinical Manifestations
543
Chronic Kidney Disease (CKD) progressively impairs multiple body systems due to the accumulation of uremic toxins, which disrupt cellular functions across various organs.Neurologic symptomsNeurologic symptoms often arise early in CKD, as uremic toxin buildup drives changes in cognitive and motor functions. Patients frequently experience fatigue, headache, confusion, difficulty concentrating, and, in severe cases, seizures. Peripheral neuropathy commonly manifests as burning sensations in the...
543
01:28Disorders of the Nervous Tissue
2.5K
Nervous tissue is a vital component of the human body's communication system, enabling us to perceive and respond to stimuli. However, like all other tissues, it is vulnerable to disorders and diseases that can significantly impact our neurological functioning.
Homeostatic Imbalances:
Alzheimer's disease manifests as a gradual decline in memory and cognitive abilities, attributed to the buildup of amyloid plaques and neurofibrillary tangles in the brain.
Parkinson's disease arises from the...
Homeostatic Imbalances:
Alzheimer's disease manifests as a gradual decline in memory and cognitive abilities, attributed to the buildup of amyloid plaques and neurofibrillary tangles in the brain.
Parkinson's disease arises from the...
2.5K
01:26Toxic Reactions: Overview
1.8K
When toxic substances penetrate the human body, they disseminate to various tissues, undergoing metabolic changes. This process yields reactive metabolites that may covalently bind with specific target molecules, resulting in toxicity.
Toxicity falls into two primary categories: local and systemic.
Local toxicity appears at the exposure site, such as protein denaturation caused by caustic substances.
In contrast, systemic toxicity requires the toxic agent's absorption and distribution,...
Toxicity falls into two primary categories: local and systemic.
Local toxicity appears at the exposure site, such as protein denaturation caused by caustic substances.
In contrast, systemic toxicity requires the toxic agent's absorption and distribution,...
1.8K