bluuebunny/crossref_metadata_2025_split huggingface dataset:
Germ Cell Tumors
Authors: Takami Hirokazu 
Published: June 2023

Abstract
Intracranial germ cell tumors (GCTs) are rare central nervous system neoplasms predominantly occurring in pediatric and young adult patients. GCTs predominantly arise in the brain midline, most frequently at the pineal region. The WHO classification defines five histopathological GCT subtypes: germinoma, mature and immature teratoma, yolk sac tumor, choriocarcinoma, and embryonal carcinoma, which are divided into germinomas and non-germinomatous germ cell tumors (NGGCTs). Tumor markers include human chorionic gonadotropin (HCG) and alpha fetoprotein (AFP) in blood serum and cerebrospinal fluid, the elevation of which typically suggests choriocarcinoma and yolk sac tumor components, respectively. Cases with negative tumor markers are diagnosed based on histopathology on surgically obtained specimens. Most germinomas are highly chemo- and radiosensitive, with non-responders accounting for less than 10%. NGGCTs are frequently resistant to standard adjuvant therapies, and sometimes require more intensive treatment, such as myeloablative chemotherapy followed by autologous bone marrow stem cell transplantation or multiple surgical resections at recurrence. Surgical resection is reserved for mature teratoma, which is curable with resection alone, and for cases with poor response to induction chemotherapy. Although approximately 60% of GCTs harbor mutations in either MAPK or PI3K pathways, no targeted therapy has been registered to date. Overall survival at 10 years for germinoma and NGGCT is approximately 90–95% and 75–90%, respectively. Long-term survivors are at risk of secondary malignancy, cardiovascular disease, and cognitive decline due to therapeutic sequelae. Progress in treatment options will include targeted therapy, immunotherapy, and dose reduction of radiation.
Intraventricular Tumors
Authors: Obiorah Samanthalee C. S. , Dowd Richard S. , Toms Steven A. 
Published: June 2023

Abstract
Intraventricular tumors encompass lesions that develop within the ventricular system of the central nervous system, comprising the lateral, third, and fourth ventricles. This chapter discusses the development, imaging characteristics, symptomatology, management options, and prognosis of common intraventricular tumors. Colloid cysts, choroid plexus tumors, intraventricular meningiomas, ependymomas, subependymomas, astrocytomas, central neurocytomas, subependymal giant cell tumors, intraventricular lymphomas, and metastases are described in the chapter. In addition, the notable imaging features on computed tomography as well as various categories of magnetic resonance imaging are included in a table to allow for both comparison and contrast among these lesions. The discussion of these lesions presented here will further the knowledge surrounding their complexities.
Metastatic Disease in the Central Nervous System
Authors: Wilcox Jessica A. , Boire Adrienne A. 
Published: June 2023

Abstract
As many one-third of all patients with cancer will harbor central nervous system metastases, with the majority of brain metastases arising from lung, breast, melanoma, renal, and colorectal primary malignancies. Circulating tumor cells gain entry to the brain and leptomeninges through multiple mechanisms, hijack vascular supply and nearby nutrients, and flourish in these unfamiliar microenvironments through a cascade of malignant evolution. Despite multidisciplinary treatment strategies involving surgery, focal radiation, and systemic therapies, the morbidity and mortality afflicting those with CNS metastases remain grim. As scientific discoveries enable improved diagnosis, genomic sequencing from tumor and cerebrospinal fluid specimens, and targeted treatments based on specific cancer and mutation subtypes, we are beginning to appreciate a trend toward increased overall survival and quality of life.
Epidemiology and General Overview of Pediatric Central Nervous System Tumors
Authors: Coven Scott L. 
Published: June 2023

Abstract
This chapter examines tumors of the central nervous system (CNS) that may be encountered in childhood. It reviews the basic understanding of glioma, medulloblastoma, ependymoma, and other less common CNS tumors. This chapter discusses the evolution of molecular characteristics, current treatment strategies, and potential pitfalls for the selected tumor types. It also briefly reviews inherited syndromes linked to childhood CNS tumors, including neurofibromatosis, tuberous sclerosis, and Li-Fraumeni syndrome. It also discusses potential late effects that may manifest as a consequence of primary management of childhood CNS tumors. Many differences exist between childhood and adult CNS tumors, and this content is written to provide a basic understanding of the pertinent issues related to childhood central nervous system tumors.
Neurosurgical Management of Pediatric Central Nervous System Tumors
Authors: Shimony Nir , Noureldine Mohammad Hassan A. , Brimley Cameron , Jallo George I. 
Published: June 2023

Abstract
Pediatric brain and spinal cord tumors are the cause of significant morbidity in children. While pediatric spinal cord tumors are rare, brain tumors are the most common solid tumor in the pediatric population. Often, these tumors have a limited response to medical therapies or patients might have contraindications for radiation. Hence maximal surgical removal of these tumors is a common primary method of treatment. Furthermore, maximal safe tumor resection offers decompression, which might lead to clinical improvement and is crucial to establish a pathological diagnosis and inform further treatment recommendations. Secondary spinal cord involvement of tumors in the pediatric population is rare because primary systemic cancer metastases occur infrequently in this age group. Primary spinal cord tumors are encountered infrequently, have limited treatment options, and require careful neurosurgical and treatment considerations. There is growing research interest in pediatric nervous system tumors with multiple ongoing trials, many with promising results for better oncologic therapies. Advanced imaging as well as advances in genetic and molecular understanding of pediatric central nervous system tumors have also helped to broaden therapeutic options for tumors that were previously deemed inoperable or otherwise difficult to manage. With many gaps remaining in the field of pediatric neuro-oncology and neurosurgical oncology, there is a need for continued patient enrollment into clinical trials to advance the field through improved evidence-based management options.
Pediatric Embryonal Tumors
Authors: Mochizuki Aaron , Partap Sonia 
Published: June 2023

Abstract
This chapter on pediatric embryonal tumors encompasses the diagnoses of medulloblastoma, atypical teratoid/rhabdoid tumor (ATRT), pineoblastoma, embryonal tumor with multilayered rosettes (ETMR), and other embryonal tumors as delineated by the World Health Organization’s 2016 central nervous system tumor classification system. Each section reviews the epidemiology, clinical presentation, imaging, and pathological characteristics as well as principles of management informed by the most recent available medical literature. Additionally, the chapter describes the evolving understanding of each tumor that has been enabled by modern molecular characterization, including the latest consensus on medulloblastoma subtypes wingless ([WNT]-activated, sonic hedgehog [SHH]-activated, Group 3, and Group 4) and the emerging insights in other entities.
Neurosurgical Management of Adult Central Nervous System Tumors
Authors: Gogos Andrew J. , Morshed Ramin A. , Hervey-Jumper Shawn L. 
Published: June 2023

Abstract
With more than 100 histologically distinct primary central nervous system (CNS) tumors in addition to metastatic disease, tumors within the brain and spine each have their own distinct symptom profile and outcomes. Neurosurgical management of CNS tumors has evolved in tandem with advances in medical and radiation oncology. For most tumors, neurosurgical intervention remains the primary method for definitive diagnosis and the first line of treatment. This chapter describes the rationale for neurosurgical intervention for specific considerations for common tumor types in adults and details surgical techniques relevant to neuro-oncology practice.
Device-Based Treatments in Neuro-Oncology
Authors: Fonkem Ekokobe , Azadi Amir , Tadipatri Ramya 
Published: June 2023

Abstract
Glioblastoma heterogeneity has posed significant challenges in developing therapies. Although it is a diffusely infiltrative tumor, it almost never metastasizes and is therefore potentially suitable for regional therapy. A major limitation of many systemic cancer treatments is poor therapeutic index given the side-effect profile of many chemotherapeutic agents. Medical devices that provide loco-regional therapy include tumor-treating fields (TTFields), carmustine wafers, GammaTile, Nativis Voyager, NeuroBlate, Visualase, and Tumor Monorail. These devices have shown much promise overall and in some cases have significantly improved survival in glioblastoma patients, in addition to often having fewer side effects than systemic therapies. This chapter provides a comprehensive overview of these devices, along with indications for their use, possible contraindications, and side-effect profiles.
Designing and Deciphering Clinical Trials
Authors: Glantz Michael , Mansouri Alireza 
Published: June 2023

Abstract
This chapter distills the essential components required for designing clinical trials of high methodological quality and reproducibility into a user-friendly instruction manual complete with checklists, charts, and algorithms. Because these are the same components and procedures required for evaluating the strength of published research, the practice of critical appraisal also is considered. To accomplish these parallel goals, the authors focus on a “baker’s dozen” design features: asking the right question, randomization, allocation concealment, masked assessment, baseline patient characteristics, inclusion and exclusion criteria, accounting for clinical trial participants, intention-to-treat, primary and secondary outcomes, sample size calculation, evaluating benefits and harms, interpreting results, and managing conflict of interest. The chapter concludes with a hope and a prayer.
The Neuro-Oncology of Women (NOW)
Authors: Gatson Na Tosha N. , Taylor Kerianne R. , Boccia Maria L. , Woodard Terri L. 
Published: June 2023

Abstract
Adult females account for nearly 60% of all intracranial tumors reported in the United States. Despite a female predominance, clinical trial and brain tumor guideline development that explore potential differences in the management of brain tumors in women are limited. This chapter brings awareness to several common concerns pertaining to the care of women with CNS tumors, reviews the supporting data for best practices, and offers important context around the neuro-oncology of women (NOW). Neuro-oncology providers have difficult conversations with their female patients about the impact that cancer and/or cancer therapies have on their survival and quality of life (QOL). These discussions often require a multidisciplinary clinical approach when addressing sex, sexuality, fertility preservation, pregnancy maintenance, pregnancy prevention, and exogenous hormone exposure risks. Key gap-issues in NOW are covered in this chapter including current treatment and surveillance guidelines as well as special considerations for pregnant women with central nervous system (CNS) tumors. Also included is information about common primary brain tumors in women, women’s sexuality, quality of life issues, and considerations of fertility preservation. As significant percentage of intracranial tumors harbored by women are hormone-dependent, more research should be dedicated to addressing NOW-related topics to best inform our patients and providers. Issues of transgender health, cross-sex hormone exposure, family planning options, and limiting sexual risks for exposure to chemotherapy in body fluids are not addressed here. We address a critical portion of the expansive subject matter relevant to NOW and hope you enjoy this review.
Acute Confusional State in the Intensive Care Unit
Authors: Wijdicks Eelco F.M. 
Published: June 2023

Abstract
There is a high prevalence of acute confusion and delirium in critical illness, and patients admitted to the intensive care unit are at high risk for these disorders. As well, patients in a florid delirium are at additional risk of medical complications for which a confusional state or delirium can be very relevant. This chapter defines acute confusional state and delirium and explains the major diagnostic considerations and laboratory tests that are necessary to evaluate these patients thoroughly. Recognition of risk factors or triggers is important so that they can be mitigated or removed when possible. The best management of agitated and delirious patients also is discussed.
Coma and Other States of Altered Awareness in the Intensive Care Unit
Authors: Wijdicks Eelco F.M. 
Published: June 2023

Abstract
On a daily basis intensivists encounter comatose patients with a variety of presentations and causes. Coma may occur from a number of reasons such as drug or alcohol intoxication, traumatic brain injury, or after cardiopulmonary resuscitation. The first course of action is to rapidly determine whether the patient is comatose. Then one should determine whether the lesion is in one hemisphere causing mass effect (fixed dilated pupil same side of the lesion with decorticate or decerebrate motor response opposite side of the lesion), in both hemispheres (no asymmetries and often brainstem reflexes intact early on), or in the posterior fossa (pupil anisocoria and skew deviation of eye position, spontaneous vertical eye movements). If there is no vascular occlusion, mass lesion, brain edema, or acute hydrocephalus, an MRI with gadolinium should be considered urgently. This chapter provides a detailed template for evaluation.
Generalized Weakness in the Intensive Care Unit
Authors: Wijdicks Eelco F.M. 
Published: June 2023

Abstract
Generalized weakness following long-term bed rest is expected in the patient recovering from critical illness or injury. This weakness becomes of great concern to intensivists when patients have marked wasting of muscle, are unable to signal with their arms, are not weaned from the ventilator despite several attempts, or are exhibiting new-onset weakness. In these cases, determining whether a critically ill patient has, in fact, a neuromuscular disorder can be difficult to assess. The major diagnostic approach in new-onset ICU weakness is to evaluate for a neurologic disorder, and this is done exclusively clinically. This chapter provides an overview of the causes of generalized weakness associated with a myelopathy, neuropathy, neuromuscular junction disorder, or myopathy in the ICU.
Acute Movement Abnormalities in the Intensive Care Unit
Authors: Wijdicks Eelco F.M. 
Published: June 2023

Abstract
Although their true prevalence is unknown, unusual movements seem common in critically ill patients, and neurologists are therefore frequently asked to interpret and treat. A neurologic consultation is triggered when these adventitious movements are recurrent, spreading throughout different parts of the body, display a rhythmicity, involve abnormal grimacing mimicking pain, or interfere with care or mechanical ventilation. Movement disorders can lead to a host of secondary complications. Dystonic involvement of the chest wall, neck, and respiratory muscles may cause acute respiratory compromise requiring mechanical ventilation. Excess (hyperkinetic) movements sustained over a period of time increase the risk of muscle breakdown. In this chapter, the clinical semiology of movement disorders seen in the ICU is described to aid recognition.
Neurologic Manifestations of Acute Hepatic Failure
Authors: Wijdicks Eelco F.M. 
Published: June 2023

Abstract
In critically ill patients, acute hepatic failure occurs in the course of multiorgan failure, acute hypotension, or cardiac resuscitation. Acute hepatic failure as a primary presenting emergency is less common in medical intensive care units (ICUs), but patients may be admitted with sudden onset of hepatic encephalopathy from acute gastrointestinal hemorrhage that causes rapid hyperammonemia. A particularly challenging management problem in the ICU is the presentation of a patient with fulminant hepatic failure. This chapter illustrates the clinical characteristics of acute hepatic encephalopathy but concentrates on the management of fulminant hepatic failure and treatment of cerebral edema. Survival of fulminant hepatic failure is now possible as a result of urgent liver transplantation.
Neurologic Complications in the Critically Ill Pregnant Patient
Authors: Wijdicks Eelco F.M. 
Published: June 2023

Abstract
Pregnancy-specific disorders such as eclampsia; the hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome; amniotic fluid embolism; and neurologic manifestations of tocolytic agents are the most common causes of admission to the intensive care unit (ICU). Obstetric admissions to the ICU are peripartum emergencies and include obstetric hemorrhage due to uterine atony or uncontrolled hypertension. Recent rupture of an aneurysm or arteriovenous malformation is sometimes seen. Some pregnancy-related disorders of the nervous system are very uncommon; others, such as eclampsia, are seen relatively frequently. Seizure control is often a reason for consultation, and the approach to management is different from that used in other conditions.
Neurologic Complications of Aortic Surgery
Authors: Wijdicks Eelco F.M. 
Published: June 2023

Abstract
Extensive surgical reconstructive repairs of the aorta increase the risk of ischemic injury not only to the viscera but also to the spinal cord. Several pathologic types of spinal cord infarction have been reported, but anterior spinal artery syndrome or complete spinal cord infarction at the mid-thoracic to low thoracic level is most frequent. The management of these patients often involves diversion of CSF and blood pressure augmentation, and consulting neurologists can be closely involved. Other complications may involve acute stroke management. This chapter reviews the scope of the problem of spinal cord infarction, its neurologic features and diagnostic evaluation; therapeutic options; plexopathies; and the sequelae of aortic dissection.
Neurologic Complications of Trauma to the Spine, Spinal Cord, and Nerves
Authors: Wijdicks Eelco F.M. 
Published: June 2023

Abstract
Trauma to the spinal cord presents first in the emergency department, but after stabilization in the field. A large number of surgical services (trauma, spine, orthopedic, neurosurgery) are immediately involved to assess the extent of injury and determine the need for emergent surgery. The role of the neurologist is initial confirmatory assessment and assistance with obtaining a detailed and full neurologic examination. Trauma to single nerves or plexus may occur and need to be recognized. This chapter provides a full overview of various types of stable and unstable spine and pelvis fractures and how to support traumatic spinal cord injury. Fat embolism to the brain is rare but important to recognize.
The Neurologist and End-of-Life Care in the Intensive Care Unit
Authors: Wijdicks Eelco F.M. 
Published: June 2023

Abstract
The time may come when physicians cannot be realistically hopeful, and intensive care is replaced by comfort and palliation. Neurologists are commonly involved in these decisions to de-escalate life support, and that is partly a reflection of the high prevalence of neurologic catastrophes in patients with a critical illness. This chapter deals with withdrawal of intensive care unit intervention in neurologic disease and its different ramifications. Withdrawal of treatment is less complicated in comatose patients. Some patients are eligible for organ donation, and these include any patient in which withdrawal of support is decided upon. In many instances, this is determined after a consensus agreement between physician and family members.
Clinical and social aspects of crime
Authors: Eastman Nigel , Adshead Gwen , Fox Simone , Latham Richard , Whyte Seán , Williams Hannah Kate 
Published: June 2023

Abstract
This chapter begins with a description of crime to the forensic psychiatrist, and the prevalence and measurement of crime. It then begins to outline the psychology and philosophy of volition. The rest of the chapter covers both violent crime and sexual crime, with a rationale for dividing violent and sexual offending in forensic psychiatry. Under violent offences it covers the social factors associated with offending, the neurobiology of violence, adverse childhood experiences, unconscious factors, a developmental perspective, gang crime, extremism, terrorism, and radicalisation, and aims to answer the question on whether mental disorders cause violence. It also covers homicide, non-fatal assaults, and fire-setting behaviours. Under sexual crime, it covers stalking, sexual offending in its social context, offences against adults, children, and other types of sexual offending.
Assessment in forensic psychiatry
Authors: Eastman Nigel , Adshead Gwen , Fox Simone , Latham Richard , Whyte Seán , Williams Hannah Kate 
Published: June 2023

Abstract
This chapter covers assessments in forensic psychiatry. It begins with an overview of the forensic psychiatric assessment, then goes on to assessments of personality and sexual attitudes and behaviour. It outlines psychological testing and test domains, then provides a list of specific psychological tests along with caveats around their use. The use of biological investigations is described. Information gathering and liaison, diagnosis, and formulation are outlined. Special issues in assessment are then covered, including in the prison setting, and working with women, children and youths, witnesses, and victims. Finally, issues relating to suggestibility and compliance are covered.
Treatment
Authors: Eastman Nigel , Adshead Gwen , Fox Simone , Latham Richard , Whyte Seán , Williams Hannah Kate 
Published: June 2023

Abstract
This chapter covers treatment in forensic psychiatry. It begins with the aims of treatment, and settings in which treatment is carried out. Coercion and treatment and the therapeutic use of security are both included, along with the DUNDRUM toolkit along with seclusion and restraint. Physical treatments, pharmacology, physical health in the secure setting, and psychotherapies are all outlined. The chapter then goes on to specific treatment modalities, including CBT, DBT, MBT, SFT, arts psychotherapies and psychodynamic psychotherapies, and group therapy. Therapeutic communities are also discussed. The chapter goes on to nursing, relational security, social work, occupational therapy, and vocational rehabilitation. Finally, evaluation of treatment and the treatment of victims are outlined.
Clinical matters raising ethical issues
Authors: Eastman Nigel , Adshead Gwen , Fox Simone , Latham Richard , Whyte Seán , Williams Hannah Kate 
Published: June 2023

Abstract
This chapter raises ethical issues within clinical matters. It begins with the concepts of mental disorders, and defines values and diversity in forensic practice, including how to avoid person prejudices. It goes on to the importance of autonomy and self-determination. Consent to treatment, and treatment during incapacity are both covered, alongside when patients refuse treatment. The chapter goes on to ask who forensic psychiatrists should treat, what counts as treatment, and consent to risk assessments and research/documentary procedures. It finishes with prosecution of patients.