PMID- 26115897
OWN - NLM
STAT- MEDLINE
DCOM- 20160513
LR  - 20181202
IS  - 1532-2653 (Electronic)
IS  - 0967-5868 (Linking)
VI  - 22
IP  - 10
DP  - 2015 Oct
TI  - Surgical management of malignant cerebral edema secondary to immune 
      reconstitution inflammatory syndrome from natalizumab-associated progressive 
      multifocal encephalopathy.
PG  - 1669-71
LID - S0967-5868(15)00230-1 [pii]
LID - 10.1016/j.jocn.2015.05.003 [doi]
AB  - We report a rare multiple sclerosis (MS) patient who developed malignant cerebral 
      edema related to progressive multifocal encephalopathy (PML) immune 
      reconstitution inflammatory syndrome (IRIS) after natalizumab discontinuation. 
      The patient subsequently required a decompressive hemicraniectomy to reduce 
      intracranial pressure and to avoid uncal herniation. PML is a demyelinating 
      disease of the central nervous system (CNS) which affects oligodendrocytes and is 
      caused by reactivation of latent John Cunningham virus. Natalizumab is a known 
      risk factor (1 in 1000) for MS patients treated with this drug. Discontinuation 
      of natalizumab treatment decreases the risk of PML progression, but a massive 
      inflammatory response can occur after cell-mediated immune surveillance is 
      reestablished in the CNS, causing immune reconstitution inflammatory syndrome 
      (IRIS). Treatment of IRIS usually consists of steroids and plasma exchange to 
      lessen the immune response, however, mortality has been reported at up to 29.4%, 
      despite aggressive medical treatment. We discuss our management strategy with a 
      review of the pertinent literature.
CI  - Copyright (c) 2015 Elsevier Ltd. All rights reserved.
FAU - Tan, Lee A
AU  - Tan LA
AD  - Department of Neurosurgery, Rush University Medical Center, 1725 West Harrison 
      Street, Chicago, IL 60612, USA. Electronic address: lee_tan@rush.edu.
FAU - Lopes, Demetrius K
AU  - Lopes DK
AD  - Department of Neurosurgery, Rush University Medical Center, 1725 West Harrison 
      Street, Chicago, IL 60612, USA.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PT  - Review
DEP - 20150624
PL  - Scotland
TA  - J Clin Neurosci
JT  - Journal of clinical neuroscience : official journal of the Neurosurgical Society 
      of Australasia
JID - 9433352
RN  - 0 (Antibodies, Monoclonal, Humanized)
RN  - 0 (Natalizumab)
SB  - IM
MH  - Adult
MH  - Antibodies, Monoclonal, Humanized/adverse effects
MH  - Brain Edema/*diagnosis/etiology/*surgery
MH  - Disease Management
MH  - Female
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/chemically 
      induced/complications/*diagnosis
MH  - Leukoencephalopathy, Progressive Multifocal/chemically 
      induced/complications/*diagnosis
MH  - Multiple Sclerosis/diagnosis/drug therapy
MH  - Natalizumab/*adverse effects
OTO - NOTNLM
OT  - Hemicraniectomy
OT  - Immune reconstitution inflammatory syndrome
OT  - Malignant cerebral edema
OT  - Natalizumab
OT  - Progressive multifocal leukoencephalopathy
EDAT- 2015/06/28 06:00
MHDA- 2016/05/14 06:00
CRDT- 2015/06/28 06:00
PHST- 2015/04/16 00:00 [received]
PHST- 2015/05/01 00:00 [accepted]
PHST- 2015/06/28 06:00 [entrez]
PHST- 2015/06/28 06:00 [pubmed]
PHST- 2016/05/14 06:00 [medline]
AID - S0967-5868(15)00230-1 [pii]
AID - 10.1016/j.jocn.2015.05.003 [doi]
PST - ppublish
SO  - J Clin Neurosci. 2015 Oct;22(10):1669-71. doi: 10.1016/j.jocn.2015.05.003. Epub 
      2015 Jun 24.