- N Engl J Med 2022; 386:2471-2481
A total of 12 pediatric patients with diffuse intrinsic pontine glioma were treated with a direct infusion of an oncolytic virus, followed by radiotherapy. The tumor size was reduced in 9 patients, and disease was stable over a median follow-up of 18 months in 8 patients.
- N Engl J Med 2022; 386:2520-2522
Most high-grade gliomas are associated with dismal survival in both adults and children, even after aggressive treatment. Despite initial promise, immunotherapy with immune checkpoint inhibitors or peptide vaccines has failed to show efficacy in phase 3, randomized trials involving patients with glioblastoma,1,2 the most common World Health Organization...
- N Engl J Med 2022; 386:1922-1931
Childhood brain tumors were previously classified by histologic appearance and location. A new classification includes genetic changes, which have prognostic significance and may lead to therapeutic targets. This review focuses on pediatric gliomas, ependymomas, and medulloblastomas.
Case 7-2022: A 65-Year-Old Woman with Depression, Recurrent Falls, and Inability to Care for HerselfN Engl J Med 2022; 386:977-986
A 65-year-old woman was admitted with depression, recurrent falls, and difficulty caring for herself. She reported weakness on the left side and had a monoplegic gait, but results of strength testing were normal. She was treated for functional neurologic disorder but then had progressive neurologic decline. A diagnostic test was...
- N Engl J Med 2021; 385:e94
A 37-year-old man presented to the neurosurgery clinic with diplopia, upward gaze palsy, and headache. He was found to have pupillary light–near dissociation on examination, as seen on a video. A midbrain lesion was seen on MRI, and biopsy showed a nonsecreting germinoma.
- N Engl J Med 2021; 385:996-1004
Although their intention was to create a model of meningioma, investigators instead observed the development of cerebral cavernous malformations in their engineered mice, prompting them to test the implicated genes in patients with these malformations.
- N Engl J Med 2021; 385:761-763
A child near death with an ALK-fusion–positive high-grade glioma refractory to standard treatment had a dramatic response when treatment with lorlatinib was begun. The drug was stopped once the child had an apparent complete remission, but treatment with lorlatinib resumed when relapse occurred 6 months later. At this time, the...
- N Engl J Med 2021; 384:1613-1622
A neurotropic herpes simplex virus that was genetically inactivated to prevent replication in normal cells was injected into the brain tumors of 12 patients with tumors that had progressed during previous treatment. Eleven patients had some radiographic or clinical responses, with inflammation detected in some PET scans. The median survival...
- N Engl J Med 2021; 384:1262-1267
A 22-year-old man presented with progressive neurologic decline. A year before presentation, painless vision loss had occurred in the left eye, followed by the right eye. During the next 4 to 6 months, diffuse numbness, limb stiffness, whole-body weakness, and urinary incontinence had developed.
- N Engl J Med 2020; 383:2404-2405
The young triathlete with brain metastases has rapidly become debilitated. But his wife, a cancer survivor, has a sagelike calm, born in part of experience volunteering with dying children. Her husband — and his oncologist — are fortunate to have such a caregiver.
- N Engl J Med 2020; 382:1150-1159
A 64-year-old man with a history of melanoma presented to the hospital after evaluation for clumsiness of the right arm had revealed a brain mass. Metastatic melanoma was diagnosed, and treatment included combination immune checkpoint inhibitor therapy. Fevers, dyspnea, and cough developed. Treatment decisions were made.
- N Engl J Med 2020; 382:937-950
Pituitary adenomas account for about 15% of intracranial tumors. Clinical manifestations of disease reflect the oversecretion of the involved hormone, most commonly growth hormone, prolactin, corticotropin, or thyrotropin. Diagnosis and management of these disorders are reviewed.
- N Engl J Med 2019; 381:1086-1087
A 52-year-old man who had received treatment for anaplastic astrocytoma presented to the ED with acute delirium and garbled speech. The initial workup identified no clear cause. It was then learned that he had been using a highly concentrated formulation of liquid marijuana at home, with 10 to 20 times...
- N Engl J Med 2019; 381:505-507
The pediatric ICU in a San Salvador hospital is so packed with patients that parents can’t spend more than a half hour at a time with their seriously ill children. One mother, knowing her son is dying, asks a visiting team of caregivers to sit with him at the end.
- N Engl J Med 2019; 381:e10
A 4-year-old girl presented with headache, nausea, vomiting, and irritability. Magnetic resonance imaging of the brain revealed a cystic mass arising from the tectal plate, with associated hydrocephalus.
- N Engl J Med 2019; 381:47-54
Brain-stem and cerebellar encephalitis without the conventional anti-Ma2 autoantibody developed in a man with a history of seminoma. Phage display was used to discover IgG antibody directed at kelch-like protein 11. The same antibody was detected in 12 other men included in an archival series.
- N Engl J Med 2019; 380:e31
A 37-year-old man presented with excessive sweating, headaches, and increasing skin folds on his scalp. MRI showed a pituitary adenoma, and a diagnosis of acromegaly was made.
- N Engl J Med 2019; 380:289-291
The CAR T cell is a recent and impressive addition to the armamentarium of medicines to treat hematologic cancers. A recent study of a mouse model of glioblastoma suggests that an engineering tweak to the CAR T cell may equip it to infiltrate and kill cells of solid tumors as...
- N Engl J Med 2018; 379:1476-1477
A recent study of inhibitors of histone demethylases in vitro and in an animal model of neuroblastoma underscores the potential of a new pharmacologic approach to treatment.
- N Engl J Med 2018; 379:1463-1463
A 32-year-old man with a family history of neurofibromatosis type 2 presented with balance difficulties and hearing loss. Magnetic resonance imaging revealed bilateral vestibular schwannomas.