The Immune System's Echo: The Phenomenon of Delayed Neurological Immune-Related Adverse Events (NirAEs) in Adjuvant Immunotherapy.

The use of immune checkpoint inhibitors (ICIs) in early-stage settings has shown promise but can lead to chronic immune-related toxicities known as delayed immune-related adverse events (DIREs). These events, occurring after immunotherapy cessation, can affect various organ systems. Fatal immune-related adverse events (irAEs) are relatively rare but significant.

Partial Recovery in Toxic Leukoencephalopathy: Is It Really a Slow Improvement or a Warning Sign?

A 55-year-old African American man who was found down by a friend nine hours after being last seen at the same place was brought to the emergency department (ED) with encephalopathy, lactic acidosis, rhabdomyolysis, elevated troponin, acute kidney injury (AKI), and transaminitis. His urine drug screen (UDS) was positive for cocaine. Intravenous (IV) Narcan was given with minimal improvement in mental status.

Clinical Reasoning: Drug Resistant Epilepsy in a 61-Year-Old Man With Abnormal MRI Brain Findings and Management With Vagal Nerve Stimulator.

A 66-year-old man with seizures that started at 61 years eventually developed drug-resistant epilepsy and was managed with medications and vagal nerve stimulation. The patient had a convulsive event at 61 years, followed by recurrent events of confusion and speech arrest lasting 30-120 seconds. He underwent gadolinium-enhanced brain MRI and angiogram, which revealed pial enhancement in the right occipital, parietal, and posterior temporal regions with subcortical atrophy.