CAR-T Cell Therapy and the Neurointensivist

We present a 38-year-old female patient with KMT2Arearranged B cell acute lymphocytic leukemia refractory to multiple lines of therapy, which relapsed within 100 days of allogeneic bone marrow transplantation as transfusion-refractory thrombocytopenia.She was admitted following Brexucabtagene autoleucel chimeric antigen receptors (CAR)-T cell therapy.The clinical course was complicated by immune effector cell-associated hemophagocytic lymphohistiocytosis-like syndrome, improving with tocilizumab, corticosteroids, anakinra, and basiliximab.The neurointensive care consultation service was asked to evaluate her after she became notably "altered" on day 16 post CAR-T cell infusion and because a new computed tomography (CT) scan abnormality had emerged.On examination, she was alert and cooperative but disoriented.No abnormalities of higher cortical function or other focality could be demonstrated.A CT scan of the brain showed bilateral hypodensities in the cerebellum and parietooccipital region (Fig. 1).