Purpose: A glioblastoma (GBM) is a primary brain tumor with significant unmet therapeutic needs. Immune checkpoint inhibitors (ICIs) have marked therapeutic benefits in many different cancers but have yet to show benefit for most GBM patients in phase III trials. Methods: A systematic review querying ClinicalTrials.gov for prospective clinical trials investigating ICI in GBM between 1950 and July 2024 was performed. Search terms comprised 11 distinct ICIs. Data abstracted include clinical trial NCT numbers with study titles and status, enrollment information, interventions, and more. Clinical trial identifying information, interventions, and outcomes were extracted. Results: One hundred and seventeen clinical trials were identified; four were phase 3. Most involved PD-1 or CTLA-4 blockade as monotherapy or in combination with standard-of-care. The large, randomized trials included CHECKMATE 143, CHECKMATE 498, CHECKMATE 548, and NRG BN007. These showed no improvement in median overall survival or progression-free survival in unselected patients. Biomarker-directed analyses suggest that a subset of GBM patients may benefit. Conclusions: ICI for the treatment of GBM has not demonstrated clear evidence of efficacy thus far. This review serves as a quick reference of ICI trial results in GBM. Biomarker-driven patient selection and/or novel approaches to overcome resistance mechanisms remain areas of viable inquiry.

Background Rapid prehospital identification of acute ischemic stroke secondary to large vessel occlusions (AIS-LVO) has been successful in triaging patients, but the use of stroke screening scales often varies. This study aims to compare different stroke screening scales for the detection of anterior and posterior circulation AIS-LVO and AIS secondary to medium vessel occlusions (AIS-MeVO). Methods We prospectively analyzed stroke alert activations at a comprehensive stroke center between August 1, 2022 and December 31, 2023. We applied eight stroke screening scales (BE-FAST, LAMS, PASS, FAST-ED, EMS RACE, 3-ISS, VAN, and NIHSS) to each stroke alert in the emergency department (ED) and inpatient wards. The final diagnosis was classified as AIS-LVO or AIS-MeVO, AIS without LVO or MeVO, intracranial hemorrhage, transient ischemic attack, or stroke mimic. Results A total of 198 patients were analyzed. The mean age was 63.9±15.3 years, 62.1% were female (n=123), and 84.3% were African American/black subjects (n=167). The LAMS scale had a strong performance (area under the curve (AUC) 0.750 (95% CI 0.668 to 0.831)), closely followed by the FAST-ED (AUC 0.736 (95% CI 0.649 to 0.822)) and the VAN (AUC 0.735 (95% CI 0.651 to 0.818)) scales. Cut-off points selected from coordinates of the receiver operating characteristic curves were 3, 3, and a positive VAN, respectively. Conclusion This is the first prospective cohort study to compare the performance of eight different screening scales among stroke alerts for detection of AIS-LVO and AIS-MeVO. We found LAMS to be the most discriminative tool, followed by FAST-ED and VAN. However, the findings were non-significant, reinforcing existing retrospective literature that these validated screening scales perform similarly and one is not superior.

Background: A type II proatlantal artery is a rare congenital vascular anomaly comprised of a persistent embryologic connection between the carotid and vertebrobasilar circulations. Although generally asymptomatic and detected incidentally, its identification is of clinical importance in neurovascular assessments and interventions. Case Description: A 70-year-old male presented with acute-onset left lower extremity weakness and numbness, out of the window for thrombolytics; computed tomography angiography of the head and neck incidentally identifying a persistent left type II proatlantal artery originating from the external carotid artery and supplying the vertebrobasilar circulation. Magnetic resonance imaging of the brain the following day was unremarkable for acute infarction or other cerebrovascular pathology. Conclusion: This case underscores the significance of recognizing congenital vascular anomalies such as the type II proatlantal artery, particularly in the context of cerebrovascular assessment. Although these variants are often incidental and not associated with increased stroke risk, their presence has implications for neuroendovascular procedures and stroke evaluations. Understanding the anatomic and embryologic origins of these vascular anomalies facilitates accurate interpretation of cerebrovascular imaging and enhances clinical decision-making in patients with these anomalies.

Spinal cord stimulation (SCS) involves the utilization of an implantable neurostimulation device, stereotypically used in the treatment of patients with chronic neuropathic pain. While these devices have been shown to have significant clinical benefits, there have also been documented potential complications, including the risk of infection, fractured electrodes, electrode migration, and lack of symptom improvement. In addition, there has been minimal documentation on gastrointestinal (GI) side effects after SCS implantation. A 42-year-old patient with chronic axial and radicular neuropathic pain in her back and left leg status post multiple lumbar surgeries underwent implantation of an open paddle lead in the T8-T9 region. After the procedure, the patient endorsed a 50% decrease in pain at the 6-week follow-up with no further concerns. However, at the 18 months follow-up, the patient endorsed severe constipation when the SCS was turned on, leading to subsequent evaluation by gastroenterology, motility studies, and a thorough bowel regimen. Symptoms persisted, and the patient ultimately opted for the removal of the SCS implant at 21 months after the initial surgery. While the exact mechanism behind the GI side effects endorsed in this patient is unknown, current literature postulates a variety of theories, including a SCS-induced parasympathetic blockade of the GI tract. Further, investigation is needed to determine the exact effects of SCS on the GI tract.

Background: Cerebral amyloid angiopathy (CAA) is a neurological condition characterized by the deposition of amyloid beta particles within the cerebral vasculature over time. A rare complication of CAA is an autoimmune inflammatory syndrome to cerebrovascular amyloid deposits. In this report, we present a case of CAA-related inflammation (CAA-RI) and discuss the diagnostic and management considerations when encountering this pathology. Case Description: A 69-year-old man with a history of hypertension, hyperlipidemia, obstructive sleep apnea, benign prostatic hyperplasia, and major depressive disorder presented to the clinic with rapidly progressive cognitive impairment over the preceding 2 months. Magnetic resonance imaging (MRI) of the brain demonstrated white matter hyperintense lesions associated with innumerable microbleeds asymmetrically concentrated in the right parietal lobe, with subtle hyperattenuation of the sulci. These findings suggested a diagnosis of probable CAA-RI. The patient was started on intravenous methylprednisolone, one gram daily for 5 days, followed by a prolonged prednisone taper over the next 6 weeks. Conclusion: Patients with CAA-RI typically present with cognitive decline, followed by focal neurologic deficits, seizures, and headaches. On MRI of the brain, T2/fluid-attenuated inversion recovery asymmetric hyperintense white matter lesions local to cerebral microbleeds are characteristic. Management of CAA-RI involves high-dose corticosteroids with emerging investigation of immunosuppressive therapies.

Background: Spinal cord stimulation (SCS) consists of the implantation of neuromodulatory devices in the spinal cord to treat refractory neuropathic pain. Although SCS technology has been proven of immense clinical benefit, complications remain including refractory pain, infection risk, and electrode migration or displacement. Till date, there are minimal reports of allergic side effects following SCS implantation. Case Description: In the first case, a 36-year-old male with chronic axial and radicular neuropathic pain in underwent implantation of an open paddle lead and generator. Within 1–3 h of activating the SCS, he developed diffuse raised erythematous hives. Over time, the SCS had immense clinical benefit for his pain reduction; however, he continued to experience recurrent hives and various other allergic reactions including facial flushing and photosensitivity. Four years later, he ultimately opted to retain the device for its clinical pain benefits. In the second case, a 35-year-old female with acute, intractable bilateral occipital neuralgia and a past medical history of Type 1 Chiari Malformation status-post-posterior fossa decompression underwent implantation of an occipital nerve stimulator (ONS). At 1-month follow-up, she began to experience pruritus across the back of her head and along the subcutaneous course of the lead. At 8 months, she continued to experience persistent symptoms, ultimately opting for device removal. Conclusion: Although allergic reactions to implanted neurostimulation systems are rare, and mechanisms not completely understood, existing studies posit multiple theories surrounding the pathophysiology of allergic reactions to these devices, such as delayed hypersensitivity reactions or contact dermatitis. Further research is needed to elucidate the cutaneous and immunologic side effects of SCS and ONS devices.