Journal of Clinical Neurology and Neurosurgery

Chimeric Antigen Receptor T-cell (CAR-T cell) therapy has emerged as a groundbreaking treatment for hematologic malignancies, offering hope to patients with relapsed or refractory disease. While CAR-T cell therapy has demonstrated remarkable efficacy in inducing tumor remission, emerging evidence suggests potential neurocognitive changes as a consequence of treatment. In this review, we explore the landscape of neurocognitive changes in patients undergoing CAR-T cell therapy, focusing on the underlying mechanisms, clinical manifestations and implications for patient care. We discuss the multifactorial nature of neurocognitive changes, including Cytokine Release Syndrome (CRS), immune-mediated neurotoxicity and Central Nervous System (CNS) infiltration of CAR-T cells. Furthermore, we examine the challenges in assessing and monitoring neurocognitive function in the context of CAR-T cell therapy and discuss strategies for mitigating cognitive sequelae and improving patient outcomes. By navigating the cognitive terrain, we aim to enhance awareness and understanding of neurocognitive changes associated with CAR-T cell therapy and optimizes supportive care measures for patients undergoing this transformative treatment approach.

Willis' circle, also known as the circle of Willis, is a crucial anatomical structure located at the base of the brain that facilitates the distribution of blood flow to the cerebral hemispheres. This vascular circle comprises interconnected arteries, including the Anterior Cerebral Arteries (ACAs), Middle Cerebral Arteries (MCAs), Posterior Cerebral Arteries (PCAs) and connecting vessels such as the Anterior Communicating Artery (ACoA) and Posterior Communicating Arteries (PCoAs). Aneurysms, abnormal dilations of blood vessels, can develop at various locations along Willis' circle, with Middle Cerebral Artery (MCA) aneurysms being one of the most common types. In this review, we explore the geometric anatomy of Willis' circle, focusing on the intricate relationships between its constituent arteries and the predisposition to MCA aneurysm formation. We discuss the clinical significance of MCA aneurysms, including their presentation, risk factors, diagnostic evaluation and management strategies. Furthermore, we examine the role of advanced imaging modalities and surgical techniques in the treatment of MCA aneurysms, highlighting the importance of individualized patient care and multidisciplinary collaboration in optimizing outcomes for patients with this challenging vascular pathology.

Gamma-band oscillations represent a key feature of neural activity in the brain and play a crucial role in cognitive processes such as perception, attention and memory. Dysregulation of gamma-band activity has been implicated in various psychiatric disorders, including schizophrenia, bipolar disorder, major depressive disorder and anxiety disorders. In this review, we examine the current state of knowledge regarding gamma-band changes in psychiatric disorders, with a focus on understanding the underlying pathophysiology. We discuss the evidence supporting alterations in gamma-band oscillations in different psychiatric conditions, including findings from Electroencephalography (EEG), Magnetoencephalography (MEG) and neuroimaging studies. Furthermore, we explore the potential mechanisms underlying gamma-band dysregulation, including alterations in neurotransmitter systems, synaptic dysfunction and aberrant neural circuitry. By elucidating the role of gamma-band oscillations in psychiatric disorders, this review provides insights into the neurobiological mechanisms underlying these conditions and highlights potential targets for therapeutic intervention.

Tinnitus, the perception of sound in the absence of external stimuli, affects millions of individuals worldwide and can significantly impact quality of life. While various treatment modalities have been explored for tinnitus management, many patients remain refractory to conventional therapies. Deep Brain stimulation (DBS), a neuromodulation technique that involves the delivery of electrical impulses to specific brain regions, has emerged as a potential therapeutic option for treatment-resistant tinnitus. In this comprehensive review, we explore the current state of knowledge regarding the use of DBS for tinnitus, including its underlying mechanisms of action, preclinical and clinical evidence, patient selection criteria, surgical techniques, outcomes and future directions for research and clinical practice. We discuss the potential of DBS to modulate aberrant neural activity within the central auditory pathway and its effects on tinnitus perception and severity. Furthermore, we highlight the challenges and limitations of DBS for tinnitus, including variability in treatment response, optimal stimulation parameters and long-term efficacy. Overall, this review provides valuable insights into the potential role of DBS as a novel therapeutic approach for the management of treatment-resistant tinnitus and underscores the need for further research to optimize its clinical utility.