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


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