High-risk smoldering multiple myeloma (HR-SMM) carries an increased risk of progression to multiple myeloma, making it an ideal setting to test whether chimeric antigen receptor (CAR) T cell therapy can achieve curative outcomes. Here in this phase 2 study, patients with HR-SMM received ciltacabtagene autoleucel (cilta-cel) at 0.3-0.5 × 10[6] or >0.5 × 10[6] viable CAR[+] T cells per kilogram without induction or bridging therapy. Patients with >40% marrow involvement were excluded. Primary endpoints were dose-limiting toxicities (DLTs) and treatment-emergent adverse events; secondary endpoints included response and minimal residual disease (MRD) negativity. As of 11 February 2026, 20 patients had been treated. The trial met the prespecified endpoints. No DLTs occurred. Adverse events included transient cytopenias (90% grade 3/4) and cytokine release syndrome (100% grade 1/2). Non-immune effector cell-associated neurotoxicity syndrome neurologic toxicities (NINTs) occurred in seven patients, with four comprising cranial nerve palsies that completely resolved. Three patients had persistent grade 1 symptoms. At a median follow-up of 15.3 months, all patients achieved MRD negativity 10[-6] by 2 months and have remained MRD negative. Sixteen patients with follow-up >6 months achieved a complete response; no progression or deaths were observed. Cilta-cel produced rapid, deep, sustained MRD-negative responses in HR-SMM without induction therapy. Toxicities were consistent with the safety profile of cilta-cel. ClinicalTrials.gov: NCT05767359 .

Background Isolated lateral rectus (LR) palsy is a common cranial nerve palsy with a variety of causes. Horizontal diplopia is frequently caused by isolated LR palsy, a common cranial nerve palsy in adults. The abducens nerve is vulnerable to a variety of vascular, inflammatory, traumatic, viral, and compressive diseases because of its lengthy intracranial journey. This study aims to describe the clinical profile, etiological distribution, and outcomes in adults with isolated LR palsy. Methodology This retrospective observational study included 29 consecutive adults diagnosed with isolated LR palsy. Demographic characteristics, clinical presentation, investigation findings, etiological diagnoses, and recovery outcomes during follow-up were systematically recorded and analyzed using descriptive statistical methods. Results The mean age was 48.17 years (range = 19-85 years), with a male-to-female ratio of 15:14. Etiologies included diabetes-related microvascular ischemia in seven (24.1%) patients, hypertension-related microvascular ischemia in seven (24.1%) patients, infection with inflammation in four (13.8%) patients, trauma in four (13.8%) patients, idiopathic causes in two (6.9%) patients, tumor in one (3.4%) patient, cavernous sinus thrombosis in three (10.3%) patients, and microvascular ischemia associated with both diabetes mellitus and hypertension in one (3.4%) patient. At the last follow-up, 19 (65.5%) patients had complete recovery, two (6.8%) had partial recovery, one (3.4%) had no recovery, and seven (24.1%) were lost to follow-up. Conclusions Microvascular ischemia associated with diabetes mellitus and hypertension was the leading cause of isolated LR palsy in adults. Most patients demonstrated improvement during follow-up, whereas traumatic and compressive etiologies showed relatively poorer outcomes. Careful systemic evaluation and targeted neuroimaging are important in patients with atypical presentations or suspected non-microvascular causes. These findings emphasize the importance of systematic clinical assessment, etiological evaluation, and follow-up in adults presenting with isolated LR palsy.

Aneurysms of the meningohypophyseal trunk are rare and usually asymptomatic, but because of the close anatomical relationship between the meningohypophyseal trunk and cranial nerves within the cavernous sinus, they can cause neurological deficits. We describe an 80-year-old woman who presented with acute horizontal diplopia exacerbated on rightward gaze. Neurological examination revealed isolated right abducens nerve palsy. Magnetic resonance angiography demonstrated an aneurysm arising from the right meningohypophyseal trunk in close proximity to the abducens nerve. Endovascular coil embolization was performed under dual antiplatelet therapy, and the aneurysm was successfully occluded while preserving meningohypophyseal trunk patency. The procedure was uneventful, although postoperative diffusion-weighted imaging revealed multiple small cerebral infarctions suggestive of distal embolism. The patient remained neurologically stable, and her diplopia gradually improved. At the 6-month follow-up, she exhibited complete recovery of abducens nerve function. This case highlights the anatomical vulnerability of the abducens nerve to compression by meningohypophyseal trunk aneurysms and underscores the importance of considering vascular lesions in the differential diagnosis of isolated cranial nerve palsies. Despite radiographic evidence of silent embolic infarction, endovascular coil embolization resulted in full clinical recovery, supporting its role as a safe and effective therapeutic option in appropriately selected symptomatic meningohypophyseal trunk aneurysms.

B-cell maturation antigen (BCMA)-directed chimeric antigen receptor T-cell (CAR-T) therapies have drastically improved outcomes for patients with relapsed or refractory multiple myeloma. While CAR-T associated cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome (ICANS) are well characterized, non-ICANS neurologic toxicities (NINTs) remain poorly defined, with limited data regarding incidence and risk factors. We performed a systematic review and meta-analysis of prospective clinical trials and real-world studies reporting neurologic toxicities following BCMA-directed CAR T therapy, following PRISMA guidelines. Random-effects meta-analysis was used to calculate a pooled point estimate of NINTs. Meta-regression was conducted to evaluate treatment-related predictors of risk. Reported NINTs were categorized by clinical phenotype when sufficient detail was available. Fifty-five cohorts comprising 4,630 treated patients were included. The pooled point estimate for NINTs was 0.81% (95% CI, 0.37-1.77%). Incidence differed significantly by product, with a significantly higher frequency of NINTs following ciltacabtagene autoleucel (cilta-cel) compared with idecabtagene vicleucel (ide-cel) (4.6% vs 0.5%; p=0.001) and experimental BCMA-directed constructs (4.6% vs 0.3%; p=0.02). Additionally, meta-regression identified cilta-cel as independently associated with increased NINTs risk compared with ide-cel. Cranial nerve palsies were the most frequently reported phenotype (32.3% 43 events), followed by movement and neurocognitive treatment-emergent adverse events (12%, 16 events), then peripheral neuropathies (7.5%, 10 events). This meta-analysis establishes that NINTs are a rare but important toxicity following BCMA-directed CAR-T therapy, particularly cilta-cel. Standardized definitions and improved reporting of NINTs are needed to better characterize risk and inform surveillance strategies.

Strabismus is derived from a Greek word, which means “eyes looking obliquely.” Strabismus means misaligned eyes. Often strabismic eyes are referred to as “squinting eyes,” “crossed eyes,” and “wall eyes.” Usually, both eyes fixate equally while focusing on an object with the head held in the primary position. In strabismus or squint, one or both eyes deviate inwards or outwards and appear to be in non-alignment towards the direction of the focused object. It can be due to refractive error or binocular fusion abnormalities or neuromuscular anomalies of ocular movements. If diagnosed and treated early, strabismus has a very good prognosis. Treatment is usually by refractive error correction, orthoptic exercises, occlusive patching, topical medications, and extraocular muscle surgery.

This study is a descriptive analysis that systematically delineates the perioperative outcome profiles of Kawase, endoscope-assisted retrosigmoid, and pterional approaches for resecting petrous apex lesions within the clinical decision-making framework of "anatomical location first." A retrospective series of 27 patients was included. Based on the core anatomical location of the lesion, surgery was performed via the Kawase approach (anteromedial region, n = 14), the endoscope-assisted retrosigmoid approach (posterior region, n = 7), or the pterional approach (superoanterior region, n = 6). The results demonstrate that surgical approaches corresponding to different anatomical subregions exhibited characteristic outcome profiles. For anteromedial petrous apex lesions, the Kawase approach achieved a high gross total resection rate (100%), but was associated with longer operative time and a higher risk of postoperative intracranial infection. For posterior lesions, the endoscope-assisted retrosigmoid approach provided excellent exposure with minimal tissue trauma and a relatively balanced complication spectrum. For superoanterior lesions, the pterional approach, while allowing direct access, was associated with higher rates of postoperative cranial nerve dysfunction (trigeminal nerve injury 50%, facial nerve palsy 67%) and speech impairment (50%). In a subgroup analysis focusing on the predominant pathology (meningioma, n = 20), these outcome differences linked to specific anatomical location-approach pairings persisted. The findings indicate that surgical outcomes for petrous apex lesions are closely associated with the approach dictated by their anatomical location, presenting a predictable characteristic profile. Therefore, clinical decision-making should prioritize the precise anatomical location of the lesion when selecting the surgical approach, and fully acknowledge the inherent perioperative risk profile specific to each "anatomical region-surgical approach" pairing. The integration of ancillary techniques such as neuroendoscopy with classic approaches holds promise for further optimizing outcomes in complex cases. This study is a single-center, retrospective, descriptive analysis with a limited sample size; its conclusions require validation by prospective, large-sample studies.