Aseptic meningitis – Severe

Signs & Symptoms

Presence of complications such as seizures, paralysis or impaired consciousness


  • 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)


  • 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