Signs & Symptoms

  • Coma
  • Acute neurological deficit (aphasia, paralysis etc)
  • Epilepsy
  • Confusion
  • Might be rapidly worsening


  • Brain MRI
  • Lumbar puncture after brain imaging: analysis of CSF for
    • white blood cell analysis (ideally including flowcytometry analysis)
    • protein level
    • glucose level
    • presence for neoplastic cells
    • infectious workup (incl. viral and bacterial analysis in CSF and blood: according to local practice and epidemiology (eg varicella, hepatitis E, HSV1, HSV2, VZV, EBV, HIV,…)
    • lactate
  • EEG
  • Autoimmune serology: neuronal surface antibodies and/or intracellular neuronal antibodies according to clinical presentation in the serum (except anti-NMDA R Ab are done on CSF (can be done later, therefore keep CSF) –
  • ICPi-related encephalitis is an exclusion diagnosis


  • Treat with following combination:
    • 1-2mg/kg methylprednisolone IV
    • 10mg/kg 3 x pd acyclovir until PCR for viral infections is negative
    • 2gr 3 x pd ceftriaxone, 500mg 3 x pd metronidazole, 2gr 6x pd ampicilline until negative cultures
    • ICU admission should be considered and cases should be discussed with a neurologist

It is also possible to download a pdf version



Anti-NMDA R Ab: Anti-N-Methyl-D-Aspartate Receptor Antibody
CSF: Cerebrospinal fluid
EBV: Epstein-Barr Virus
EEG: Electro EncephaloGram
HSV: Herpes Zoster Virus
ICPi: Immune Checkpoint Blockade Inhibition
ICU: Intensive Care Unit
HIV: Human Immunedeficiency Virus
MRI: Magnetic Resonance Imaging
PCR: Polymerase Chain Reaction
VZV: Varicella Zoster Virus