Signs & Symptoms
Presence of complications such as seizures, paralysis or impaired consciousness
Evaluation
- Brain MRI to exclude brain metastasis and leptomeningeal involvement
- Lumbar puncture after brain imaging: analysis of CSF for 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)
- blood analysis for lactate
- Open pressure measurement (done during lumbar puncture)
Management
- 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