{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T16:43:04Z","timestamp":1781196184913,"version":"3.54.1"},"reference-count":19,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,12,29]],"date-time":"2022-12-29T00:00:00Z","timestamp":1672272000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Hematology Reports"],"abstract":"<jats:p>Usually used in emergency settings, bedside sonographic measurement of optic nerve sheath diameter can aid in diagnosing elevated intracranial pressure. We report a case of a 26-year-old male hospitalized for CAR T-cell therapy with Axicabtagene Ciloleucel for treatment of relapsed diffuse large B-cell lymphoma, who developed progressive symptoms of immune effector cell-associated neurotoxicity syndrome. Fundoscopic examination suggested the presence of blurred optic disc margins. Bedside ocular ultrasound revealed wide optic nerve sheath diameters and bulging optic discs bilaterally. The patient had a ventriculostomy placed for monitoring and received treatment with steroids and mannitol, as well as tocilizumab. After 7 days in the ICU, the patient recovered with no evidence of long-term neurological deficits.<\/jats:p>","DOI":"10.3390\/hematolrep15010001","type":"journal-article","created":{"date-parts":[[2022,12,30]],"date-time":"2022-12-30T05:15:53Z","timestamp":1672377353000},"page":"1-8","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["It Is in the Eye of the Beholder: Ocular Ultrasound Enhanced Monitoring of Neurotoxicity after CAR-T Cell Therapy"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2912-152X","authenticated-orcid":false,"given":"Juan Esteban","family":"Garcia-Robledo","sequence":"first","affiliation":[{"name":"Division of Hematology\/Oncology, Mayo Clinic, Phoenix, AZ 85054, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Valencia-Sanchez","sequence":"additional","affiliation":[{"name":"Department of Neurology, Mayo Clinic, Phoenix, AZ 85054, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Molly G.","family":"Knox","sequence":"additional","affiliation":[{"name":"Department of Neurology, Mayo Clinic, Phoenix, AZ 85054, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brent P.","family":"Goodman","sequence":"additional","affiliation":[{"name":"Department of Neurology, Mayo Clinic, Phoenix, AZ 85054, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison C.","family":"Rosenthal","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology, Mayo Clinic, Phoenix, AZ 85054, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhavesh","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Mayo Clinic, Phoenix, AZ 85054, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Januario E.","family":"Castro","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology, Mayo Clinic, Phoenix, AZ 85054, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2531","DOI":"10.1056\/NEJMoa1707447","article-title":"Axicabtagene Ciloleucel CAR T-Cell Therapy in Refractory Large B-Cell Lymphoma","volume":"377","author":"Neelapu","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1056\/NEJMoa1804980","article-title":"Tisagenlecleucel in Adult Relapsed or Refractory Diffuse Large B-Cell Lymphoma","volume":"380","author":"Schuster","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1080\/14712598.2021.1889510","article-title":"Brexucabtagene autoleucel for the treatment of relapsed\/refractory mantle cell lymphoma","volume":"21","author":"Mian","year":"2021","journal-title":"Expert Opin. Biol. Ther."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1016\/S0140-6736(20)31366-0","article-title":"Lisocabtagene maraleucel for patients with relapsed or refractory large B-cell lymphomas (TRANSCEND NHL 001): A multicentre seamless design study","volume":"396","author":"Abramson","year":"2020","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1016\/j.bbmt.2018.12.758","article-title":"ASTCT Consensus Grading for Cytokine Release Syndrome and Neurologic Toxicity Associated with Immune Effector Cells","volume":"25","author":"Lee","year":"2019","journal-title":"Biol. Blood Marrow Transplant."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1038\/nrclinonc.2017.128","article-title":"Chimeric antigen receptor T-cell therapies for lymphoma","volume":"15","author":"Brudno","year":"2018","journal-title":"Nat. Rev. Clin. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1038\/nrclinonc.2017.148","article-title":"Chimeric antigen receptor T-cell therapy-assessment and management of toxicities","volume":"15","author":"Neelapu","year":"2018","journal-title":"Nat. Rev. Clin. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1182\/bloodadvances.2019000952","article-title":"Comparing CAR T-cell toxicity grading systems: Application of the ASTCT grading system and implications for management","volume":"4","author":"Pennisi","year":"2020","journal-title":"Blood Adv."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1158\/2159-8290.CD-17-1319","article-title":"Clinical and biological correlates of neurotoxicity associated with car t-cell therapy in patients with B-cell acute lymphoblastic leukemia","volume":"8","author":"Santomasso","year":"2018","journal-title":"Cancer Discov."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1001\/jamaophthalmol.2017.6560","article-title":"Ultrasonography Assessments of Optic Nerve Sheath Diameter as a Noninvasive and Dynamic Method of Detecting Changes in Intracranial Pressure","volume":"136","author":"Wang","year":"2018","journal-title":"JAMA Ophthalmol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1007\/BF01627611","article-title":"The subarachnoid space surrounding the optic nerves. An ultrasound study of the optic nerve sheath","volume":"18","author":"Hansen","year":"1996","journal-title":"Surg. Radiol. Anat."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1284","DOI":"10.1007\/s00134-018-5305-7","article-title":"Optic nerve sheath diameter measured sonographically as non-invasive estimator of intracranial pressure: A systematic review and meta-analysis","volume":"44","author":"Robba","year":"2018","journal-title":"Intensive Care Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1177\/0284185118776501","article-title":"Ultrasonographic optic nerve sheath diameter to detect increased intracranial pressure in adults: A meta-analysis","volume":"60","author":"Kim","year":"2019","journal-title":"Acta Radiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.1093\/brain\/awz053","article-title":"Neurological toxicities associated with chimeric antigen receptor T-cell therapy","volume":"142","author":"Rubin","year":"2019","journal-title":"Brain"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1973","DOI":"10.3389\/fimmu.2020.01973","article-title":"Neurotoxicity and Cytokine Release Syndrome after Chimeric Antigen Receptor T Cell Therapy: Insights Into Mechanisms and Novel Therapies","volume":"11","author":"Siegler","year":"2020","journal-title":"Front. Immunol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"18741","DOI":"10.18632\/aging.104058","article-title":"A comprehensive analysis of the fatal toxic effects associated with CD19 CAR-T cell therapy","volume":"12","author":"Cai","year":"2020","journal-title":"Aging"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1212\/WNL.0000000000006436","article-title":"Cerebral edema secondary to chimeric antigen receptor T-cell immunotherapy","volume":"91","author":"Wierda","year":"2018","journal-title":"Neurology"},{"key":"ref_18","unstructured":"Schneiderman, H. (1990). The Funduscopic Examination. Clinical Methods: The History, Physical, and Laboratory Examinations, Butterworths."},{"key":"ref_19","first-page":"111","article-title":"Consensus guidelines for lumbar puncture in patients with neurological diseases","volume":"8","author":"Engelborghs","year":"2017","journal-title":"Alzheimer\u2019s Dement. Diagn. Assess. Dis. Monit."}],"container-title":["Hematology Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2038-8330\/15\/1\/1\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:55:19Z","timestamp":1760147719000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2038-8330\/15\/1\/1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,29]]},"references-count":19,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,3]]}},"alternative-id":["hematolrep15010001"],"URL":"https:\/\/doi.org\/10.3390\/hematolrep15010001","relation":{},"ISSN":["2038-8330"],"issn-type":[{"value":"2038-8330","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,29]]}}}