Severe (Aseptic meningitis)


Presence of complications such as seizures, paralysis or impaired consciousness


  • Brain MRI to exclude brain metastasis and leptomeningeal involvement
  • Lumbar puncture after brain imaging: CSF
    • white blood cell analysis (ideally including flowcytometry analysis)
    • protein level
    • glucose level
    • presence for cancer cells
    • infectious workup (incl. viral serologies and (myco)bacterial analysis in CSF and blood according to local practice)
    • lactate
  • Open pressure measurement (done during lumbar puncture)


  • Suspend ICPi
  • Patient should have neurological consultation
  • Exclude infectious causes before start of steroids
  • ICU transfer for symptom management and exclusion of other causes
  • High dose prednisone according to local practice
  • No response within 1 week: consider second line immune suppressants




CSF: Cerebrospinal fluid
ICP: Intracranial pressure
ICPi: Immune Checkpoint Blockade Inhibition
ICU: Intensive Care Unit
MRI: Magnetic Resonance Imaging
NSAID: Non Steroidal Anti-Inflammatory Drugs